51145 LOT NO,
NO. 'STR F.F.I'
Pf ��'
ll FOR PLUMBING PERMIT
Wa
.i i I Y OF CUPF.RTINO
x 0 MVAR 17 1966 sanitary No.
¢ LL
0 ' Date 196— Permit No
a
3 " �� C �PQJINO Fee S
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1 ati is h re y ma e 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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Use of Premises
00
r3 Owner -/ Address
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COONTRACT , AGENT
3 W Phone ;7-1– 5Z-1 (//
W¢ Wa
C3 b-23d– $ca7 Approved State License
a 0U IS PLUMBING INSPECTOR /
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111X I UREb
UNITS FEES UNITS FEES
Water Heatc SizC
Water Closets Material C.L
-Bath Tubs j To Curb
Showers To Prop. Line
Lavatories 3 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
Cam . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material 941,
San Traps TOTAL FEES
Urinals Fixture Fee , O
Area Drains Main Drain Fee
�ater Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee , C�
TOTAL777,7' TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final