2691 102le/Z E LOT NO.
APPLICAT 4- FOR PLUMBING PERMIT
w Z (APR 17 1964 )'ciTV OF CUPERTINO
r o Sanitary No. /�J,J
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< p�lY 4 !X11 X196 Permit No
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w LL Fee $ /'6.017
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� Application is hereby madeto 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
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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0 a Use of Premises r�si
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Phon State License 7-- '99 - Approved HtNtf*dTmsV&'tbR
FIX I URESh I DRAIN
UNITS FEES UNITS FEES
Waren Heater / 710-6Size //
Water Closets hfateca_•
Bath Jobs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
DishWashers Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Alater Softeners Material
Bar Sinks To Main Drain
Comb, Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains. WATER SYSTEM
Hoppers Size f//
Restaurant Sinks Material
Sats Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
'Nater Leaders Storm Drain Fee
Sprinkler Naives Water Sys. Fee ,QD
Permit Fee
TOTAL // 11601 TOTAL FEE (p,
RECORD OF INSPECTION
Underground Rough._ 3D -
.Partial Rough_ - 3
.Rough. Complete..
Main Drain q-
Final---