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® PPC�C%CTICEfICUPERTINO
PLUMBING PERMIT
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°a Sanitary No ^�
3 a Date 196. Permit No
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CITY UV UU Fee $ Or v
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes fixtures accordance with
fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or in accordith the provisions of the Plumbing Code of the City of
wi Cupertino, and all laws applicable r C7
w Use of Premises
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3 Owner J 0-1411
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ao State Licensed V 3 / D _Approve
Clot U PLUMBINGINSPECT OR
1'1.11 V[l l:J N1 IN BER 4
UNITS FEES UNiTS1 FEES
Water Heater Size i
TT—at—CF—C70—sets Material I
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 }'..
Mashing Machines Size
Water Softeners 7,00 Material
Bm6-.Sinks To Main Drain
Comb. .Sink'h' r To Curb i
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DPit FouFounta�ins
ow Dom ! rains _ WATER SYSTEM - I
-TITP-11erN Size I
Restaurant Sinks Material ;
San raps TOTAL FEES
Urinals Fixture Pee ♦1 d
Area Drains Main Drain Fee
VV—,,ter Leaders Storm Drain pee
6(rinker Valves _ Water Sys, Fee D Q i,
Permit Fee
TOTAL TOTAL FEE tl d i
RECORD OF INSPECTION —�
Underground Rough,..
.Partial
:Rough. Complete.. p
�1ain Drain
1'final...