100222 LOT NO.
NO. ST F.FI'
APP�ATI P PLUMBING PERMIT
z < CI71Y D .UPERTINO
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Y ° L 2 q 1970 sanitary No.
¢ fp0 2s i
o ' Date 19 Permit No
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a LL rr __ '� CtRb KSFy�1IF Pee $
O ApplicatGATYheOF m4�plio 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 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a Cupertino, and all other laws applicable thereto `
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Use of Premises i "L L /
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- 0 Phone / '—�J�a
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c o State Lic nseA�/6 7 TSS Approved /
U PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pron. Line
Lavatories To Existing
Kitchen NotConn.
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
Ho er Size
Restaurant Sink Material
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lv
Sand Tra TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Le der Storm Drain Fee
Sprinkler System Water Sys. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee