1981 (2) LOT NO /
® R PLUMBING PERMIT \'
W : f MAR 5 1>s0f F CUPERTiNO
x o Sanitary No.
3 U Date I9� Permit No Q
= LL Fee$
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o< pipes and/or fixtures 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
W Cupertino, and all other laws applicable thereto.
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Owne Address
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ate License 6 ` / App
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UNITS FEES U?tfTSl FEES
Water Heater Size _
ater C osets Material
Bath TubsAn To LUrb
Showers n To Prop. Line
Lavatories p To Existing
Kitchen inkNot Conon.
as e er
DisosalsWsaste
_
Wash Trays STORM DR NAGE
\ as mgMac inns Sizo
"Water So teners Material _
Bar Sins To Main Drain
tot;b.Jink a frays To Curb
Dcnta Units
rm mg Fountains '
floor Drains WATER SYSTEM
oppels Size
Restaurant Sinks Material
SaAd Traps TOTAL FEES
rings Fixture Fee /2 O0
rea r� ams Main Drain Fee
WaterLeaders form Drain F
Leoc
Sprinkler Valves Water Sys. Fee QQ
Permit Fee Q
TOTAL —
TOTAL FEE
RECORD OF INSPECTION
Underground Rough.
'.Partial Rough.. —�
:Rough. Complete.. 11i3
.Iain Drain 4 11a r A;
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Final...
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