2437 (2) ror NO.
NO. STREET -
Ct2ON FOR PLUMBING PERMIT
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w < C OF CUPERTINO
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20 / Sanitary No.
o < Date �I SEP 1 _ Permit No a
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Ap t n er �,�(�ity of Cupertino for a permit to install plumbing
a w e g � �;•°r�v Fee$
o a pipes an /or xtures M d he erre 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 other3 ads applicable thereto.
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0 Use of Premises
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oOwners .Z Address_ _
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zxB - 'Address -
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3NXPhone �''y '1- s8"8� OV171c
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apX State LicenseApproved �f`
X_ IJRES NUN BFR MAIN
UNITS FEES UNITS FEES
Witter Heater / SiZe s21 Z
W tern Closets 6 Matcral
Bath Tubs To Curb
Showers j To Prop. Line
La'Satories To Existing
Kitc`—Teen Sinks Not Conn.
Dish Washers ,3 13 Sewer Boxes
Waste Dispose s
Wash Trays / STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb.— 3NIV rays To Curb
Dental Units
Drin mg Fountains
I oor Drains WATER SYSTEM
Floppers Size / /•-a
Restaurant Sinks Material
SinF1 raps TOTAL FEES
rine(.T is Fixture Fee '23
A r 715rains Main Drain Fee „Z Tf
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Pee /6-0
Permit Fee O e-T1
TOTAL j°_ TOTAL FEE 02L
RECORD OF INSPECTION
Underground Roughq.
;.Partial Rough..
Rough, Complete../)
7,in 15rain
Final...