51177.1LOT NO.
A"CA.(TIONFOR PLUMBING PERMIT
Y
OF
ERTINO
Sanitary No.
Da q 19620 Permit No. 7 7
,�� !` Pee $
AlfAtion is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the 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
Cupertino, and all other laws applicable theret2.
Use of Premises
Phone`%f
State License irfG, F29
as
7 A'-,
x'1 -17 -?0
Approved 1/
7 PLUMBING INSPECTOR
-s 166/
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material C
Bath Tub
/
To Curb
Shower
To Proo. Line ✓
Lavatories
To Existing
Kitchen '
`�
Not Conn,
Dish Washer
Waste D'soral
Wash Tra
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
DrinkingFountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee i
Water Leadertoren
Drain Fee
Smkler System.
Water Sys. Fee
Relief Valve
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee •� �
Total
/
Total Fee �7(f.