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1983 (2) cm No. 13 Fff 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 = d • 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� 00 >m / � o i Own Address /&G o 6. LC� z l AZ Addres aLi CO AGENT —0 Y one NZ mm , 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