2482 No. POP t0 ,OR PLUMBING PERMIT
z < CL Oi-- CUkRTINO
E 8 1963 4 -
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o a Date,��' -�/'� 196 Permit No
w� CqY' OF CUPERT:110 Pee $ a�
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i a and/or, fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other la applicable thereto.
Use of Pretriises
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ao State Licens -Approved �l -7
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets ro Materia'_
Bach Tubs 4/ , pv To Curb
Showers To Prop. Line
Lavatories To Existing .
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
*sVater Softeners Material
tiar Sinks. To Main D in
Comb. Sink s Trays To Curb
Deptal Units _
Drinking Fountains 1
Floor Drains .rlD WATER SYSTEM I
Hoppers Size/�/ 0 -'
Restaurant Sinks Material et
San .Traps TOTAL FEES
Urinals Fixture Fee Cp
Area Drains Main Drain Fee gyp
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee e7"
Permit Fee
TOTAL TOTAL FEE p�
RECORD OF INSPECT
Underground Rough..
.Partial Rough-
RoughComplete..
\'Iain Drain
Final...