51028 f 7
i / I ' LOT NO.
NO. STRF.F.
TION FOR PLUMBING PERMIT
z � - Y OF CUPIiRTINO
M o Sanitary NO.
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o J Date 2 96 Permit Nos/ a 2-e
5 <
w LL Pee
� o �1p�tp�
�t�f�lati�i s hWkd��lJgo2 City of Cupertino for a permit to install plumbing
o 1- pips• n /o xtu I s reverse side hereof, and agrees to install said prices
> 1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino,,and all Other laws applicable thereto.
LL Use of Premises • ✓,
00
oa OwneLy� Addressda
ZJ _
z By^/Y�/ Address
— O CONTRA'TOR, ENT
Phone
ao State License�l� '3.TL— Appr
—UPLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water HeaterSize
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tra� STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.SinkBTray ToCu�b
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker /
Skimmer /
Filter
Permit Fee pZ. d'%
Total 06,p dl Total Fee