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N
-- P ICIN
PP,LICIN FOR PLUMBING PERMIT
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r[IY OP CUPERTINO
r V 15 966t Sanitary No.
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o J Date 196 Permit No
3 `
wCITY OF CUPERTINO Pee $
2 LL
O 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 prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w i Cupertino, and all < ter laws appli thereto.
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J LL
Use of Premix
00
9/OS 7U
0 3 Own ddres
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J z Addre
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3: ;-, ONTRA 90R,'AGENT
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a /7 `�� 30
a o `�S{.ttaate LiterPe Approved
U C PLUMBING INSPECTOR
FIXTURES 1
UNITS FEES UNITS FEES
Water Heatc SizC
_NV9?tei Closets Material
Bath 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
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Pee
tVater Leaders Storm Drain Fee
Jprinllcr Valvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
R'ECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alain Drain
Final