51226N
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7-2, V7 1 At_ � LOT NO. /D
NO. tlotEF.T
eAP L ftT N FOR PLUMBING PERMIT
®tt OF CUPGRTINO
UatrK G 67l In
Sanitary No.
Permit No. SloalloG
Fee SW a
A}y�4jc@�ior(�iSheppgRTt��i�oe City of Cupertino for a permit to install plumbing
pipecalwd or1fizture jiste 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 thereto.
k,K. COUNr OK %,`,f. 3161¢ R
FIXTURES
NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To ProD. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
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
Hopper
Size
Restaurant Sink
Sand TrapTOTALFEES
Urinal
Area Drain
eFixture
e i -n
Water Leader
eeSprinkler
System
Bell
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee )-O'a
Total
Total Fee