51145 o/ 7c)/ I U o LOT NO.
NO. STPEEI
® A FOR PLUMBING PERMIT
W �jtY�OF CUPERTINO
xz ��11JJJJ�i Sanitary No.
SEP _
Y o + }� 1966 /
oa Date
" 96 G �O Permit No S��
3CITY —
i W � r!�p['p-� p Fee S
o Applications is he7eYy' dtel JN110 City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applic le hereto.
r �
LL Use of Premises
i- Ad jkjt �'"•�
zj
z tBy \ / C Addres /
L FAN TRACTOR, AGENT
3 �_� _- C' / lf'
- N
Phos
W Z
a o State LicentP Approved'
U PLUMBING INSPECTORy/
(� I
FIXTURESD 11
UNITS FEES UNITS FEES
Water Iicate 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 u Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
=—Dans
Fixture Fee p O
Main Drain Fee
Storm Drain Fee
Wafer Sys. Fee ,� aermt Fee jp D
TOTAL FEE , D U
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final