51075.1 J I / LOT NO.
1003
SNoPP/NCr
APSLCk FOR MBNG CEJ
PERMIT
z ` CITY OP CUPERTINO
z -
z o Crry OF CWEnM
r Sanitary No,
o j Date 197L Permit No,
L-
3 `
u
w Fee $ 7- 0,0
O Applic�Ao* I1repmade to the City of Cupertino for a permit to install plumbing
o a pipes and/Or'fixtures listed on the reverse side hereof, and agrees to install said prices
i I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x
LL Use of Premises
00 QQ
o a Owner �7 C.0 Address
zJd
orF
0 By COeNTRALLCTOR`, A ENT Address
3 m Phone—a}`g lil� 1 qW M l40
w wP-T�
ao . /State License �- Approved
U p� PLUMBING INSPECTOR C�
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories xi tin
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
--Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material -
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stom Drain Fe
S rinkler S stem Water Sys.Fee
Relief Valve I Gm Fee
D
Vac Breaker +
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee