1980 (2) /0 3 ( LOT NO /
No. STaee
1 FOR PLUMBING PERMIT
W i
RAR
OF•CUPERTINO
5 Sanitary No.
LL 1q o
Date 196_ Permit No.
a Fee$�` 41—
x o 0
M ArJilaliodQ heQl7fek 1 K0Gty 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
WW Cupertino, and all oth laws applicable ther e`
Wx
M
J LL Use of i n
00
o 3: Address %Goo •.
2J
o By Add
-N ORE
W 2
tate License �� `% 6 7 Approved
G
—T-T7T9Rr9-- NUI BER M
UNITS FEES UNITS FEES
Water Heater Q Size
ater C osets ;00 terial
Rat ubs O To Cur _
Showers 00 ToProp, Line
Lavatories _O O To Existing
Kitc en Sin cs Not Conn.
Dls Was ers ewer Boxes
Waste Disposa skq
\Y/as Trnys STORM DRA• AGE
Was Ing Machines AlmSim _
'Rater So teners Material
Bar Sin is To Main Drain
Comb. Sink&Trays To Cur
Dental Units
Dnn ing•Fountaihs
oor Dom— WATER SYSTEM `
oppers • Size �.
Mate
Restaurant Sinks rial
art raps TOTAL FEES
Urinals Fixture Fee (906
rea rams Main Drain Fee 00
Water Leaders Storm Drain Fee
Sprinkler Vnives Water Sys. Fee Q
Permit Fee
TOTAL TOTAL FEE
RECO OF INSPECTION
Underground Rough.
:Partial Rough.. — —�
:Rough: Complete..
Main Drain
Final... I —