51064 eoro LOT NO.
® Ma APPFOR PLUMBING PERMIT
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(SE P 16 1965 U.
OF CUPEiRTINO
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s o Sanitary No.
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o f . 196— Permit No
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Fee $ 16.91
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
'o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said pri cs
r . 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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0 W Use of Premises
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O CONTRACTOR, AGENT
Phone 7 6
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z u State License 99 7 % Approved
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U PLUMBING INSPECTOR v
FIXTURES N
UNITS I FEES UNITSI FEES
Water Heate Size
Wate; Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Feep'D
ea&ra' // Main Drain Fee
r ��ers / Storm Drain Fee
K -kE ve: Water Sys. Fee
Permit Fee CTD
OTAL -271 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final