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CJAfI *"FORPLUMBING PERMIT
a C 0F.CUPLRTIN0zwpa 5 1963 t " S:mitary \b.
o a Date 196— Permit No. of O/
o I Y OF UPFRTIi��O Fee $
Ap Ic tion is here y ma e 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 N and/or fixtures in accordance with the provisions t Plumbing Code of the City of
a w Cupertino, and all o r law ap I' able theret
0 o Use of Premises -
3 Owner Address'
Address
o
3 r• CON ACTO AGSM
— m P
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a o' to Licens 6 Approved
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• ''� PLUMBING INSPECTOR
i
I NI MAIN DRAIN
UNITS FUF;S UNITS FEES:
Water Heater Size e
Water Closets Material
Bath Tubs 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 LLL To Main Drain
Ce)mb. Sink s Traysi To Curb
Dental Units
Drinking FouffJuisi
Floor Drains, WATER SYSTF.MI
Hoppers Size
-
Restaurant Sinks Material _
San Traps _ - -TOTAL;FEES.
Urinals Fixture Fee
Area Drains_ Main Drain Fee ,
Water Leaders Storm Drain Fee:
Sprinkler Vaives / Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough... -
.Partial Rough..
Rough. Complete.. -
Main Drain
Final...