51226 (2)/ lK. ? v'• A Aze� LOT NO, Z/
NO OTREET
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
512 26
U. 196— Permit No
Fee S
(�4'�ica(1� is����RaTl he City of Cupertino for a permit to install plumbing
p es and or fixtures listed nn t e 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:
Use of Premises
CONTRACTOR, AGENT
Phone �1+'
State License 4 7 y ko
N
Approved
INSPECTORPLUMBING
rl ATVKO! Cour at-
FIXTURES
kFIXTURES NUMBER
Units I Fees
Water Heater
Water Closet
Bath Tub
Shower
Lav
Kitchen Sink /J?7
Dish Washer
Waste Disposal
Wash Tray
Washing Machine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water
Sprinkler System
Vac Breaker
Skimmer
Filter
Pool Sweeper
Total
31341
MAIN DRAIN
Units Fees
Size
Materia
To Curb
To Prop. Line
To Existing
Not Corm,
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size
Materiao
TOTAL FEES
Fixture Fee
Main Drain Fee
Storm Drain Fee
Water Sys. Fee
JD
Permit Fee
Total Fee