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J4!x NR PLUMBING PERMIT
�pu L 1968 I i F CUPERTINO
15 1968 195_ Permit No. IS V/
CITY OF CUPERTINO
Fee$ 0?' 25,0
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of
Address
Address S?y e -
PLUMBING INSPECTOR V
rlXTURES NUMBER
MAIN DRAIN
I UNITS I FEES
I
IUNITSI FEES
Water Hcater
I Size
Water Closets I
�� Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains)
II
Floor Drains I 1II
--R-oppersl
WATER SYSTEM
1II
Size II
Restaurant Sinks
Material I I
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
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Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Vatvcs
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION