1545 OT NO.
NO. STREET
ORELAW
OR PLUMBING PERMIT
® IF CUPERTINO
4MAY 381962 _
t Date _ Permit No.
F CI�PERtiNO Fee $ ,
e a °=
Appll�Y ion is�ereby made to the 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-off the City of
Cupertino, and all other lawi applicable thereto.
Use of Premises
0
w Owner Address
Bys Address
_ CONTRACTOR, AGENT
�C Phone Approved
PLUMBING INSPECTOR
i ,
FIXTUR[S NUMBER MAIN DRAIN
UNITS FEESII UxrTsl FSEs
Water Heater I Size
Water Closets Material
Bath Tubs To Curb
Showers _ - .I I To Prop. Line
Lavatories I I I To Existing I .
Kitchen Sinks Not Conn.
Dish Washers I - II aFWFR wnxwa I
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines I Size
Water Softeners F1 Material
Bar Siriks I. To Main Drain I I
Comb. Sink a Trays) I I To Curb -
Dental Units _
Drinking Fountains) II I
Floor Drains WATER SYSTEM
Hoppers -I Size I_
Restaurant Sinks Material
Sand Traps I TOTAL FEES
Urinals I I I Fixture Fee IO'
Area Drains MainDrain Fee r ®-U
Water Leaders I Storm Drain Fee
Sprinkler Valves I I II Water Sys. Fee
oV II _Permit Fee b'O
TOTAL 'II .TOTAL PEE
RE R ECTION
Partial Rough
Rough Comp to
Final 2