2686 COT NO.
NO. %
RIFOR PLUMBING'PERMIT
a V
OF CUPERTINO
Zi APR 151964
x o Sanitary No, c
0 a Date 96_ Permit No'--
o 2 O
CITY OF CUP 6 Fee s
° Application is hereby made 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other laws applicable thereto.
w x
Use of Premise
00 (�
> 0 l
o a Owner % res
/ � I� Adds Q
zJ
Jo �yvNl ✓FASA ��SPR)rK< F�tc- Address S o Ise/441- Ar 9 S�
CONTRACTOR, AGENT
3 �:
- `m ghonr.c V
w z
ao &tate Licens O S �� Approved
_U
PLUMBING INSPECTOR
UNITS FEES JUNITS FEES
Water Heate Size
Water Cosets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitc en Sinks Not Conn.
DIs Washers Sewer Boxes
Waste Disposals.;
as'h Trays STORM DRAINAGE
Was ing Machines Size
Water So teners . Material
Bar Sinks To Main Drain
Com . Sink & trays To Curb
Dentel Units _
Drin ing Fountains'
Floor Drains WATER SYSTEM _
op'erF�s Size
Restaurant Sinks Material
an raps TOTAL FEES
la s Fixture Fee
ea rains Main Drain Fee
tX/ater Leaders Storm Drain Fee
—
Sprinkler Valves Water Sys. Fee
Permit Fee
' TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
\lain Drain
Final...
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