NO PERMIT NUMBER (3) CXJ I S z I M2,dzti GLG P? 0) , LOT NO.
NO. STREET
r ION FOR PLUMBING PERMIT
W ` ® OF CUPERTINO
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s X Sanitar No.
AUG a6&- s
° j Date 6So Permit No
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U Fee S V
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pp i aU is I � {�t��e City of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures ise'Aii�ltWeJreverse side hereof, and agrees to install said prices
'z Iand/or fixtures in acwrdance with the �rovi ons of the Plumbing Code Of the City of
< w Cupertino, and all other laws applic' le eret�
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Approved
111111"''''"'''' J''✓
PLUMBING INSPECTOR
FIXTURES NU
_ mS UNITS FEES UNITS FEES
ate: tate 11 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
`(rash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
�ater Leaders Storm Drain Fee
Sprink,et valves Water Sys. Fee 400
Permit Fee 0-n
TOTAL TOTAL FEE V D
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final