1745/c
v
�n
10 1 / e- LOT NO. 9
NO. STREET 1401, —
N FOR PLUMBING PERMIT
=OF CUPERTINO
195_ Permit No.
�oo
T��// ((�� (� (U� Fee $
jSlititidh�is her �r -MRdT4o 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, and all other laws applicablePKeretp.
Use Of
By
CONTRACTOR, AG
Phone
INSPECTOR
rl TITRIi UDiB • MA DR
UNITS FEES ��
- IUNITSI FEES
Water Heater I
Size
Water Closets II
Material
Bath 'Tubs I II_T0
Curb I I
Showers I I I
To Prop. Line l '
Lavatories I
To Existmg�, I
-Kitchen Sinks I I
Not Conn. I I
Dish Washers I
SEWER BOXES I -
VOdste Disposals I I
Wash Trays II
I
STORM DRAINAGE
'Washing Machines II
Size
f Water Softeners I I
I Material I
.B 9 oks I
Main Drain
-Comb. Sink & Traysl
_To
I To Curb
'i Dental Units--I��
kDtihking Fountains) I
I
1.Floor DrainsI
J WATER SYSTEM
r Hoppers I
ILSize I I`
Restaurant Sinks I I
I Material
;'S� and I'raPs I I
I TOTAL FEES_
U is I
II Fixture a Fee � 00
,
- Area Drains ,,1,,,
I Main Draih,Fee I
W� Ater Leaders I ;,,I
Storm Drain'Fee
Sp'Pkl• Vnives ,�
• 1 9ei���
Water,
Permit Fee r. a,ao
i��i�cs
F I TAL I
I TOTAL FEE Q
RECORD OF INSPECTION
' Partial Rough
'. Rough Complete
Final