51145 a�✓OC J I "'�iif/JGCi/AA.I'� LOT NO. �oCV
NO. STREET
T FOR PLUMBING PERMIT
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OF CUPERTINO
wi FrAJP &r
I oR 4 1966 sanitary No.
° j Date 196_ Permit No
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U nC /� Q nI(� O O
I LL ^fIP C 'd1F ttF6��,HT1bt2K Fee S 7 .�
° � ati is h e City of Cupertino for a permit to install plumbing
$ a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws ap)h ble theret .
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Use of Premises
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`m Phone 37CJ'
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3 State License ���`7�7 Approved /
< 0yPLOMBWG INSPECTOR
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FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath 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
L\/ate-Softeners Material
Har Sinks To Main Drain
Comb. Sinks 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 nZ.d_'
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee / 0--S
Permit Feec1�
TOTAL TOTAL FEE 7 Vc
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alain Drain
Final .