51145 aI SIS �ytih //Lf��� 196C LOT NO
I'R FOR PLUMBING PERMIT
z a Y OF CUPERTINO
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1 uL 19(� Permit No, ��
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U CUp Fees (f � 0
Application is here y i a1VQ the City of Cupertino for n 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
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Cupertino, and all other laws applicable thereto.
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4 f 2 30 4 43 ��/ -� .�����
0 0 State License Approve
- 0 PLUMBING INSPECTOR -'
FIXTURES
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 Material
Bar Sinks To Main Drain
Com . Sink , Trays
To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
�, Size
Restaurant Sinks Material
' T*eps C/vrnr TOTAL FEES
I3eiwQls iLTE7( Fixture Fee 4C-fV
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
-rankle, Velvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
final