51145 (2) NO. STREET
APP A` IOM FOR PLUMBING PERMIT
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z ® �1Y OF CUPERTINO
x p ! Y 3 Sanitary No.
¢ LL Lasa
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o a Date 196— Permit No
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0 �pjjYC1t.OFis hQVffRT1V City of Cupertino for permit
to install plumbing
o < Pipes 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
c w Cupertino, and all other laws applicable thereto.
w x
0 4 Use of Premises
o_ o
> N
r 3 Owner Address
o LCROWN PLUMBING CO. INV' A90WN LUMBING CO. INC.
a y P 6�>�eX �9
3 r CO. TOR,AGENT OE buz
`m Saratoga. a L�ornta Saratoga, California
— Phone
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a o/ State License Z 7 el 642? Approved
Ur PLUMBING INSPECTOR
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FIXTURES J
UNITS FEES UNrrS FEES
Water Heate Size
Water Closets 3 Material
Fath Tubs To Curb
Showers To Prop. Line
Lavatories 3 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 Ad
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material AG
San Traps TOTAL FEES
Urinals Fixture Fee /I
Area Drains Main Drain Fee ,t70
Water Leaders Storm Drain Fee
Sprinkler Volves Water Sys. Fee ,pU
Permit Fee JQ
TOTAL TOTAL FEE t7
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final