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51125 (3) 14W I aA*I-/ 4/� LOT NO, NO. STs F.F.I' `AP Lj%AT41 FOR PLUMBING PERMIT z p` © 9 Y OF CUPERTINO x ° IDEC 30 1965 Sanitary No. o Uare 196— Permit No 3u` 00 i LL �s �/ (�� Fee 5 �3 ° L glyatiLnfis fld�a♦f haIRT1 1l oe 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 prices > I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of a w Cupertino, and all other laws a licable thereto. .� w x � r a Use of Premises 00 ? a a Owne / Address /��p i/�1117�✓ Z J Q , By ��/��- Address ° CONTRACTOR, AGENT 3r w z Phone ww a a o State License Approved PLUMBING INSPECTOR '/ Pix I URES UNITS I FEES 11 49 UNITSI FEES Warer Heate Size Water Closets Material Bath Tubs To Curb Showers To Prop. Line Lavatories A 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 San Traps TOTAL FEES Urinals Fixture Fee ,0 Area Drains Main Drain Fee �V—ater Leaders Storm Drain Fee Sprinkler Valves Water Sys. Fee Permit Fee , 0�0 TOTAL p, TOTAL FEE 00 RECORD OF INSPECTION Underground Rough Partial Rough Rough. Complete 'Iain Drain Final