100104 LOT NO.
NO. TREF.I'
N a PL�ICATIOIaFOR PLUMBING PERMIT
z COF CUPERTINO
K 0 0C 27 1966 Sanitary No.
3 a Date
/� T�/ /�C r 196E Permit No /0
i LL
CITY I l;f l���PEERR--�� �pI((�� Fee $
0 Application is hereby ma�'e' the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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a o State Licensr Approved
Uf .ps .PLUMBING INSPECTOR 'V/
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FIXTURES NU,% 13ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
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 Material
Bar Sinks To Main Drain
Com . Sink &Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Storm Drain Fee
Sprinkler Vntvcs Water Sys. Fee i D U
Permit Fee .0 0
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...