100081 J/6 LOT NO.
NO. Sn
® 1 FOR PLUMBING PERMIT
OF CUPF.RTINO
r o1j,fAPR 15 1966 Sanitary No.
¢ /0-0, 0 8/
o a Date 196_ Permit No
3
w LL
CITY OF, ,e yPE�tTINO Fee $
= o
App ication is here y ma e 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
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
LO
Cupertino, and all other Taws applicable thereto.
w =
0 w Use ;ofaP ,,e,,00Owni iT7s/ Address
z� cc
z By �11� Address
O CON00eR�,/A' TNT
w z /
ww /
ao State License'>_/�"�"p3�M�N Approved
VI PLUMBING INSPECTOR
FIXTURES D
UNITS FEES UNITSI FEES
Water Haatn 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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee „Z .E
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Jpnoklrt valocs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 07
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final