1156 7 M A ,z�, LOT NO.
No STREET
TION FOR PLUMBING PERMIT
� OF CUPERTINO
Dat ® Mt ri 4M W 195_ Permit No.
l4 ��ppFee $�
1� AVT*iooF h 1EaBeltbTT'�n�'�n/�llJM City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed 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, another laws applicable th a o..
Use of remise � 'W �
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AA } �t.(t
Own � n'l� _ C. � 1 ems. Address I
By Address l./
I R \ �
D h\rle r u�{! — APpr e
PLUMBING INSPECTO
—FIXTURES NUMBER MAIN DR IN
UNITS FEES UNITSI FEES
Water Heater i I Size
Water Closets aterial
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Coon.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines II Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink &-TraysI 1 11 To Curb
Dental Units I
Drinking Fountains) itROW
_
Floor Drains I WATER SYSTEM
Hoppers Size I I_
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Varves I Water Sys. Fee
soypq 1 11 Permit Fee I /
TOTAL FEE
ECORD OF INSPECTION
Partial Rough
Rough Complete
Final i