840 (2) NO. STREET
VpFOR PLUMBING PERMIT
OF CUPERTINO
JUL 2t
Date 195_ Permit No.
CITY OF CUPERTINO �®
Fee$
Application is hereby,made to the 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
x and/or fixtures in accordance with the provisiops,of the Plumbing Code of the City of
't Cupertino, and all oth`e'r law'sa pliable th to.,
480
Use Of Pre nis'
v a '1
S. �'
Owner./ �G Addressl 774-- �4 �e�a
By''' ' Address
CONTRACTOR, AGENT i
1;
Phone Approve d
t PLUMBING INSPECTOR 1
�,'
FIXTURES NUMBER M IN DRAIN
UNITS FEES UNITS I FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To PropLine
Lavatories jj, To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
'),Washing Machines Size
Water Softeners Material
sBar Sinks To Main Drain
Comb. Sink &Trays 11 To Curb
Dental Units 1 �I
Drinking Fountains) ;I
Floor Drains I Il WATER SYSTEM
Hoppers
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals _ �� Fixture Fee Q
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sp t kler Varves Water Sys. Fee _
Permit Fee I . 0e)
TOTAL TOTAL FEE �, Q/)
RECORD OF INSPECTION
Partial Rough
Rough Com tete �
Cz
Final (,O