511790 <
wz
Wil
I,✓//l�L����%L rY�ILG�/ LOT
NO. —S EE.T!
ON FOR PLUMBING PERMIT
C OF CUPERTINO
Sanitary No.
Permit No.
Fee$a Ja
pipes ium� rnfiohress14,tMmlh oielr of Cupertino fora permit to install said
pring
es
ersc side hereof, and agrees to install said ruses
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
By ;"f?2An/
CONTRACTOR,AGENT �—
Phone
State License
%'Jr%fir
M
VALLIAM D. ZE—NIZ ICIA
PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
UNITS I PEES UNITS FEES
Water Heater / Size
Water Closet Material C/
Bath Tub / To Curb
Shower / To Proa. Line 4/
7-
Kitchen Sink
Dish Washer
0, Comb.Sink & Trav I 1- 11 To Curb
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
/'rV
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
24v -
Total
Total Fee
...�.5�