NO PERMIT NUMBER ///�/� i /✓ � / 'r i"_ LOT NO.
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
za CITY OF CUPERTINO
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Sanitary No.
3j Date//" , 196/7 Permit No
QR 2 $ �95� ��. Pee $
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
'o a pipesTnd/or,fixtyues,listed-on,the reverse side hereof, and agrees to install said prices
> 1- and/orYfixtures m acordange with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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a U Slate License ������ - Approved N
FIXTURES IN BER MAINDRAIN
UNITS FEES UNITS1 FEES
Water Heater Size
Water Closets Ma'cria'•
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners .OG Material
Bar Sinks To Main Drain
Comb. Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Arra Drains Main Drain Fee
Water Leaders Storm Drain Fee
7-priAler -Valves Water Sys. Fee
Permit Fee
TOTAL {!pp TOTAL FEE
RECORD OF INSPECTION
Underground Rough... .I
Partial Rough__
.Rough, Complete_
\•Iain Drain
Final...