51145 2/✓/T �� �L�Y� CT LOT NO.
NO. STREET
w !°ALP.PLl�C�ATLR,,N,, FOR PLUMBING PERMIT
z -
Y OF CUPERTINO
C fJAN 13 19Qr sanitary No.
Y °
C LL .fwo-
° � Date 196_ Permit No
3 `
U Fee $ 7 a►
�TF ' RT�Np
All 1 h ati rs hey e 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
i 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
.. Use of Premises
00 —'
3 Owner G✓ Address
o a
ZJ
-/��rC_I_K.td S
= ° By C�yON7 ncroR. AceNr Address �
3 `m Phone
w z
a o 0
State License ,?30) Approved
U PLUMBING INSPECTOR /
t/
fX I URES ;\tBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories 4To 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 a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Sizeir
Restaurant Sinks Material eo
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee 1. 00
Water Leaders Storm Drain Fee
Tp—,,7,k Valvcs Water $y5. FeeJ.
Permit Fee '
TOTAL LAL_ TOTAL FEE Q
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.lain Drain
Final