2163 ID LOT NO. g&
NO.
® Q OOR'`�LUMBING PERMIT
C13Y' O
W .t F
CUPERTINO
x o /JUN 13 1963 A�' Sanitary No.
3 < Date �� �11,96Z Permit No
iU .C� Y OF OPERTNO Fee $
a
° Application is hereby made to the City of Cupertino for a permit to nstall plumbing
0 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other lawpplicabl thereto.
Use of Pren.----
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0 o State License -Approved
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PLUMBING INSPECTOR
FIXTURES NUN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size W
Water Closets Material
Bath Tubs 1.ppj 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
Water Softeners Material
Bar Sinks _ To Main Drain
Comb.:Sink c Trays To Curb
Dental 'Units `
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers - Size
Restaurant Sinks Materia
San ,Traps TOTAL FEES
Urinals Fixture Fee r.
Area Drains Main Drain Fee ,
Water Leaders Storm Drain Fee, - '••'
Sprinkler Vawes Water Sys. Fee'
Permit Fee h,
TOTAL TOTAL FEE �7
RECORD OF INSPECTION
Underground Rough_,.
.Partial Rough..
.Rough. Complete..
\•Iain Drain
Final...