51145 (2) �✓7� �.�N//� LOT NO,
NO. STItEEI
fLIjA I FOR PLUMBING PERMIT
" a VMAR
Gi "'E I OP CUPERTINO
° 17 1966 $:mitary ,� ,.
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o Date 196— Permit No.
a
3 U Pee S
°
AIQTl tim0 he}lf,�GiERTIlNW City- of Cupertino for a permit to install plumbing
o a pipes and/or fixtures It 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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� r
Use of Premises
o_ o
> N
3 Owne -Address
O J
z B Address
J a NTRACTUft, AGENT
3 I 37 9
— `m Phone
-
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ao State License C36 Approve
- 0 ` PLUMBING INSPECTOR I
FIXTURES M
UNITS FEES UNITSI FEES
Water Heate Size
Water Closets 3 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 & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /`'
Restaurant Sinks I Materialq.9
San Traps TOTAL FEES
Urinals Fixture Fee - &C
rca Drains Main Drain Fee o) y-p
V(ater Leaders Storm Drain Fee
Jprinkler Vdves Water $y5. Fee �,CO
Permit Fee Grp
TOTAL TOTAL FEE I
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final