51121 STE E
?fPMAR
I FOR PLUMBING PERMIT
25 1965 OF CUHMNO
x p Sanitary No.
° < Dat096- Permit No SIla-
i LL OF CUPPLERTIN
Fee $
° Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in awof4nce with the provisions of the Plumbing Code of the City of
a w Cupertino, and al other ws applicable he to.
wx C
r r
LL Use of Premises
00 0
3 . Owner Address a I,
0 < p
z B Address ,
° CO�11'R OR,
z Phon
SCO
w z
ao State Licen � y v Approved
-U 1j 7� / PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water 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 m Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
lo
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
7VXrater Leaders Storm Drain Fee
Sprinkler Valves EaSys. Fee
Permittet Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete-
Main Drain
Final...