51037 1 L
V4, * *4d ^ Vii A LOT NO.
NO. STREEI'
fo�4P�E�� TION FOR PLUMBING PERMIT
CUPERTINO
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� U, e 196— Permit No
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_ CITY11 CUPtRTING
Ili , n I I t the Cit}' of Cupertino for a permit to nsta I Plumbing
`o a pipes an /or fixtures istc on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City, oC
a w Cupertino, and all 0 r la &41icable thereto
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4 Use of Premises {�
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3 Owner _ Address
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OCONTRACTOR, AGENT
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aState Licen ApproveUP
11IX I URFSNUMBER
UNITS I 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
XVash 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 Material
San Traps TOTAL FEES
UrinalsFixture Fee
Area-Dans r �
i4ECORDSPECTION
Main Drain Fee w
Water LeadersStorm Drain Fee
Sprinkler ValvcsWater Sys. Fee
Permit Fee
O ALTOTAL FEE
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Underground Rough
Partial Rough
Rough. Complete
\Iain' Drain
Final=