2175 NO. SIRE LOT NA.
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LtI��T R PLUMBING, PERMIT
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3 0_ ! ��� Sanitary o. _
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¢ Dat 19� Permit'No �21
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R6dL t�t'1' 1 Fee $ J,
° A6L ,jiogFhe 0 the City of Cupertino for a permit to install plumbing
o a pipe and or xtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
- ¢ n Cupertino; and all other-laws'ph�c '-there - - - - - - - - - - - —
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Use of Premises
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oaOwner ��� Address S(rn�V✓OI{�
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3CONTRACCOR,AGENT
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ao State License /S�a3f - Approve
. -U , i PL[JMBING�IN$pPCfO�R
1NU' MAIN DRAIN
.
UNITS FELS UNITS FEES'
Water Heater Size
Water—Closets Material
Nath Tubs To Cur
ShowersTo Prop. Line
Lavatories To Existing
Kitc eI�e Sinks FWATERSYSTEM
f Conn
Dish Washers
Waste Disposals
Wash Trays AINAGE
\Y/ashing Machines
-Watt,; Softeners
Isar Sinks
CW4Sink &Trays Trays '
;Dental Units _
`DriAktng Fountains
Floor Drains _ M',_
'Hoppers LSize
-Restaurant Sinks Material
SaneTraT ps — TOTAL FEES
€ rinalC s Fixture Fee
rerains
Main Drain Fee
Water Leaders Storm Drain Fee
t` klrr vmves Water Sys. Fee
i Permit Fee sem.,
6
'TOT TOTAL FEE
i
RECORD OF INSPECTION
Underground Plough...
f ;Partial Rough-
.Rough. Complete..
.V4ain Drain
Final... I