51075.1 LOT NO,
NO. STREET
FOR PLUMBING PERMIT
a i ro ti" OF CUPERTINO
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Y 0 /N O Sanitary No.
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3 a Date 19�7U Permit No
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isW- K he City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures lists bii tlSe reverse side hereof, and agrees to install said prices
> 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.
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.. Use of Premises '-Z Q -
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oa OwnerG /', , / � e Addresses"/ + /� Aq
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3 CONTRACTOR, AGENT
— W Phone 2-6 �' t
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ao State License �i � Q Approved
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PLUMBING INSPECT
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FIXTURES INUMBER 11 MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet L11 Material
Bath Tub To Curb
Shower To Prom. Line
Lava To E ' tin
q 16"11 Not Conj],
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
fFflte
al Unit
Drinking Foul)' i ,r Draw \/ ATER SYSTEM
er �7 eaur2nt,Si IF 9 !Ai erial
T�'I TOTAL FEES
al1�� V ' Lure Fee
Dr - in Drain Fee
fiFe
nkler S stem t ater Sys.Fee', O\Breakermerr SweeperPermit Feel Total Fee