NO PERMIT NUMBER c6 /W Z—e I FL/;.y-5 Q _JS_-�=rte_ LOT NO.
NO. STREET
AeP1 N C 11 FOR PLUMBING PERMIT
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U '�i 26L Permit No
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Fee 5.,/•
° APPICpTt��Yry is�!e�eb���� i of Cupertino fora permit to install plumbing
o a pipes a�ldy rlfixftires Inttd`rlrr'tlltTCe�sc side hereof, and arees to install sid prics
'z m and/or fixtures in accordance with the provisions-of the Plumbing Code of the City of
< w Cupertino, and , o r laws app a l thereto.
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-0[ PLUMBING INSPECTOR
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-1FIXTURES NUIXIBER
UNITS 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
Wash-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners If Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size77
Restaurant SinksMaterial
San Traps TOTAL FEES
Urinals Fixture Fee --
Area Drains Main Drain Fee
Vater Leaders Storm Drain Fee
:-pri"kil VVulves Water Sys. Fee
Permit Fee ` ,Q
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain -
Final