2749 ✓ee0 LOT NO.
NO. STREET
CRA I FOR PLUMBING PERMIT
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OF CUPERTINO
° 1964 sanitary No.
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o Date 196— Permit No
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UTY Fee S Q
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� �l1c`at7on her y a e to e 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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all oWlawslicable theret0oUse of Premises
3 Owner o % Address
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3 CONTRACTOR, AGENT
— W Phone
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a o State License /� 7,� S� Approved
—0 PLUMBING INSPECTOR
FIXTURES D BER MAIN DRAIN
UNITS FEES UNITSI 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
Comb. Sink s Trays To Curb
Dental Units
Drinking;Fountains
Floor Drains WATER SYSTEM
HoppersSize
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
re DDrains Main Drain Fee
�Uater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL \ SL-2-1 TOTAL FEE au
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
Hain Drain
Final...