51087 LOT NO.
Q S EP.
FOR PLUMBING PERMIT
v OF CUPERTINO
xo ,/F 1966 Sanitary No.
LL
o a Dat 01961, Permit No.
3 LL Pee $ —
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`opipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other la s app icable thereto.
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LL Use of Premises .
00 3 Owner �u Address
oa "
Z By Address
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— m Phon O
a
o State License -- bJ Approved
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_L)� CONTRACTOR, AGENT t0000e
HXTURES \ ER MAIN DRAIN—
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Material
Hath 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
'seater Softeners Material
Har Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains i
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sp,mklcr ValvesWater Sys. Fee
Permit Fee
TOTAL TOTAL FEE 0-
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
.Main Drain
Final...