2431 NO.
�y��yLji� LOT NO.
FOR PLUMBING PERMIT
d
TFISEP121963
yOP CUPERTINO
sanitary No.
3 a Date 196_ Permit No
CITY OF C��PERTIN® Fees
W_ W
Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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.
w x
0 o Use of Premises
aa Owner d/ .(Y,� Address .S d
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z 3y •�- �-�� --�,�,,.� Address
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a o State License / k-- 7 1/ Approved '�/ ^
I,Ix I URFSNUMBER AIDRAIN
UNITS FEES UNITSI FEES
Water Heater / Size
Water Closets � „Z, Mates'_
Bath Tubs / To Curb
Showers / / To Prop. Line
Lavatories Z To Existing
Kitchen Sinks / Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
mashing Ma—ch inesSize
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink v Trays To Curb
Dental Units
Drinking Fountains Adak
door Drains - WATER SYSTEM
Hoppers' Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee y.a
)Vater Leaders Storm Drain Fee
Sprinkler Naives Water Sys. Fee O"
Permit Fee y
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete.. 1 p — �!
Main Drain .r- J-
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