1511��/ I ✓- - LOT NO.
NO. STREET
4- Pp
IONFOR PLUMBING PERMIT��OF CUPERTINODa 6219� Permit No. 511
Fee $ 7
CA;Yicaff Is tQM 1a1N�
to he City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
v
Owner Address
By
CONTRACTOR, AGENTLAW f.
Phone — /1 �T Approve
PLUMBING INSPECTOR
SURES NUMBER MAIN DRAIN
UNITS FEES
UNITS I FEES
Water Heater I �I
Size
Water Closets
Material
Bath Tubs
To Curb
Showers'
To Prop. Line
Lavatories
Kitchen Sinks
To Ex'
NC62poZ
Dish Washers
SEW - -R BOXES
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners
Material
I
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Units
Drinking Fountains � �I
-Dental
Floor Drains ��
WATER SYSTEM
Hoppers I
�� Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
ji Fixture Fee 2 ,5
Area Drains
Main Drain Fee , 00
Water Leaders
Storm Drain Fee
Sprin er Vaives I I
II Water Sys. Fee
Permit Fee / . O
TOTAL
TOTAL FEE /
4 :vtpertino,Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
[/Sewer Connection Sanitary Permit No....–� ..........................
❑ Plumbing Final Plumbing Permit No -1-6-1 .
�o Lot No- ----------------------------
Owner or Tenant --- ••••-- ------------------- .............
Tract ----------t,T,�c --- ----
Date Connected --- - -----------------
Date Final ---•-------•------ ----------
lit 1/60-500
•----------------------