51087 ��:'� ^� e �/- ^�: LOT NO.
No. ATI FOR PLUMBING PERMIT
a OF CUPERTINO
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f?JrAN779! 5
r o Sanitary No.
O a Date — '— 196 Permit No
/O S
w LL CITY OF CUP RTINO Fee S
' 0 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
z I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all o ler laws applicab thereto.
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a Use of Premises
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f State Licens L Approved
PLUMBING INSPECTOR ✓
FIXTURES NUMBER
UNITS I FEES I UNITSI 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
Com . 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
Arca Drains Main Drain Fee
Zrater Leaders Storm Drain Fee
Jprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final