51087 i �
� LOT NO.
APPLICATI OR PLUMBING PERMIT
'Z `z IFFEB 3 1966 OP CUPERTINO
' 0 Sanitary NO.
M4
o �3 Date 06Z1, Permit No
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W LL Pee $
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� Application is hereby, made to the 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other Xpph/cable thereto.
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LL Use of Pre ices
0 3 Own erJ Address ��
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� o $y C Address /a4 Jr,
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a ��State License � Approved
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FIXTURES 1 BER MAINDRAIN
UNITS FEES UNITS FEES
Water Hcater Size
Water Closcts Mates:
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
.Vater Softeners yad Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
IIoor-Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE O-!�—
RECORD OF INSPECTION
Underground Rough...
.Partial Rough-
.Rough. Complete-
Main Drain
Final...