51001.2 qx/ Vr LOT NO,% Q
NO. STREET I t
APPL ION—p PLUMBING PERMIT
< O PERTINO
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� o '• Sanitary No..
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0 a Date 62 .. _ B 21 196 ,( Permit No.
3LL Pee $ a6 -SO
O A licatio 's eb ad o i of 1 u ertino for permit to install plumbing
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o` < pipes and/or Tiict�rCs Iis t�d on`t}k reverse side hereof, and agrees to install said prices
=m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
LL Use of Premises - -�-'^��
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3 0 CONTRACTOR, AGENT
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ao State License �'30 %�J/ Approved
—1 I. PjUMBING INSPEC[OR ✓
FIXTURES NMN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate / Size /
Wate: Closets �, Mater
l
Bath Tubs To Ciaurb
Showers / To Prop. Line y14-
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
Comb. Sink s Trays To Curb
Dental Units g i //✓G /
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size ,i /
Restaurant Sinks Material UjAcV
San Traps TOTAL FEES
Urinals Fixture Fee /(o„ 0
rea Drains Maip Drain Pee 00
Water Leaders Fee /,J-0
Sprinkler Valves Water Sys. Fee /, fp
Permit Fee 0 O
TOTAL TOTAL FEE 6,SO
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete-
Main Drain
Final---