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LOT NO,
?('SI FOR PLUMBING PERMIT
z EP 3 �96� ti} OPCUPERTINO
r o Sanitary No.
o j Date r� �9(i,�` Permit No J-113 7
a
3LL CIT Fees
' 0 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.
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a Use of Premises_ --
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o a Owner i �v(�- iYA (Adc}re z/ 1,3 si— k
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� , By Address
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o s Slate License )j�L Approved
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- 0 f\ PLUMBING INSPECTOR
F1. R JIN
UNITS FEES UNITS FEES
`X/ater Heate Size
Ware; 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
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
twinkler val.-es Water Sys. Fee 'tt ,
Permit Fee 1 dam_
TOTAL ! TOTAL FEE Lf(DO
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final