51145 (3) I,� LOT NO. K DG
NO. STAE F.T
jFrAPR
FOR PLUMBING PERMIT
OP CUPf3RTIN0
wSanitary No.4 1966 1
0 LL
0 'a llare T�/ (+ [[� In',(�196_ Permit No
3 LL ki 1F�,P4aB�Tb1P1tr Fee$ �6 U
o
� A 1 do he t i Cit}' 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
wCupertino, and all other laws applicable thereto.
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.. Use of Premises
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3 Owner Address
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J z Address
O CONTR C OA AGENT
— 0 Phone
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u � /2 Approved
�O 7y
FF 4 o State License
I PLUMBING INSPECTOR /
FIXTURES NUMBER
UNITS FEES UNITS FEES
Water Heatc Size
Water Closets Material
bath Tubs To Curb
Showers j 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
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee Vie=
Nater Leaders Storm Drain Fee
Jprinklrr Valves Water Sys. Fee �=
Permit Fee
TOTAL TOTAL FEE o0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Hain Drain
Final