100029 5 I LOT NO.
NO. 0
IkP - T FOR PLUMBING PERMIT
d OF CUPERTINO
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i p V Ply. � 1965 Sanitary No.
o a Date 196 S Permit No /00
LL CITY OF CUPERTINO Fee $ .544w
O Application is hereby made 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
> and/or fixtures in Yccrdance with the provisions f the Plumbing Code of the City of
wCupertino,-and- 1- er-laws-a plica ther —-- - ----- — -- - -
Use of Premis
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CONTRACTOR,AQGENT
3 0 Phone. 023s�.Z� 7 S s
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U 7 77to License / Approved
PLUMBING INSPECTOR
FIXTURES nMAIN DRAIN
UNITS FEES UNITS FEES
`.Cater Heart 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 . Sinks Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
re-Drains Main Drain Fee
�Y/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
'Iain Drain
Final._.