51145 (2) o!���� I �� Lor x0. •�07�
NO.
F/W ON FOR PLUMBING PERMITw � C Y OP CUPERTINO
o Sanitary No.
° J Date S � 6— Permit No,
3 `
u
q'T�/ n�. - Pee 5
° ppl ati a l���1 to the City, of Cupertino for a permit to install plumbing
`o a pipes and/or fixture i id reverse side hereof, and agrees to install said prices
i a and/or fixtures in accordance wiPlf the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
wF /
a Use of Pr es
00
oa Own`r / Addresj' 60 Q®
zJ
o By Address
3 CO ENT
AGENT
– Phone `�3–
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a Ul ,State Licence Approved (�
f1— PLUMBING INSPECTOR
FIXTURES 1
UNITS FEES UNITS FEES
Wacer Heatc Size
Wate, 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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee C-0
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee pt7
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final