1983 cm No. 13
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RPLUMBING PERMIT
iZ As C �ec'C �QF CUPERTINO
rc t[ J OW
g o Sanitary No. .
a -
o i Date 196_ Permit No
U MEW! Fee f fl
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• o Application is hereby made to the City of Cupertino for a permit to install plumbing
WW< pipes and/or fixtures listed on the reverse side hereof, and-agrees to install said Prices
'Co and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
m Cupertino, and all other laws applicable thereto.
WX
J , Use of Premises Q�
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o i Own Address /&G o 6. LC�
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CO AGENT
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tate License d: W App <
PLUMBING INS
UNITS FEES UNITSI FEES
Water Heater Size
ater osets Materi _
Hath Tubs To ur
Showers To Prop. Line _
Lavatories To Existing
KA en in Not Conn.
Dls Was ters / er Bo
xes
Waste Dlsposa s /
Wash Trays STORM DRAFPAGE
as ing Mac Ines p Sizc
'.'Vater Softeners Material
ar Sin To Main Drain
Com . Sink a Trays To Curb
Dents Units
rin m Fountains
t+oor r¢ins WATER SYSTEM
oppers Size
Restaurant Sinks Material
an raps TOTAL FEES
rtna s Fixture Fee
res rains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee
106
Permit Fee
OTA — TOTAL FEE
RECORD OF INSPECTION
Underground Rough..
:Partial Rnugh..
Rough: Complete..
Main Drain
Final... 1.1