51038 — I 0 X44. Q LOT NO.
NO. ST EEI'
W p -R ATION FOR PLUM PERMIT
z a" (• n CITY OF CUPp:RTINO
o Sanitary No.
O -' Dat J ', 196 Permit N ' — 0'3
a
3� I
i Pee $J3'16w
0 i, the City of Cupertino for a permit to install plumbing
o a pipes andWfix 6 11 R be reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and al her laws appl11 thereto.
Use of Premise I /��'� (,�L'1-•�
00 0
o a Own ilJ -lit1. L.�-(� � Addre s d
o $.' in"s"CXI-,6- Address/ 44t-Oe-
3 a
a?
CONTR OR, AGENT
Mon
a o State Licenses' Approved �
lU PLUMBING INSPECTOR
FIXTURES Dt
_ UNITS FEES UNITS FEES
Warer Heaie 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
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
ZV/ater Leaders Storm Drain Fee
-prinklar Valves Water $y5. Fee
Permit Fee 00
TOTAL _ - TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final