2115-PLUMBING PERMITLOY NO.
NO. STREET
APZUCAJION FOR PLUMBING PERMIT
D ' ,I OF CUPERTINO
Sanitary No.
Date Permit No
Fee $
Ap temre}��j�t�"ity of Cupertino for a permit to install plumbing
pipes aT r fiQhres W fof3 Q�ie' reverse side hereof, and agrees to install said paces
and/or fixtures in accordance with the provisions - the Plumbing Code of the City of
Cupertino, and all other laws applicable theret .
Use of Premises 122"S
Addre 3 no 4 u 1
Pju1Z�i �> G ✓�
Address L o
ApproveWILLIAM D. 13ENEVIGN
i1 WS4J'M1WGq ISAfiCV0R
UNITS I FEES UNITS FEES
Water Heater Size
Water Closets Matera!
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existine
Sewer Boxes
aste Disp,
ash Trays
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
,Drinking Fountai;zs
Floor Drains
WATER SYSTF
Hoppers
Size
Restaurant Sinks 1
11 Material
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee
Permit Fee
RECORD OF INSPECTION
Underground Rough...
.Partial Rough—
Rough Complete..
''Iain Drain
Final...