NO PERMIT NUMBER / 9 LOT NO.
h0. T
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A FOR PLUMBING PERMIT
Y OF CUPERTINO
w X ,,MAY 27 19%
x o Sanitary No.
C LL
3 a Da 196-5 Permit No
U I
2LL Fee $
o Application is hereby made to the 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
i
t
U) and/or fixtures in accordance with the visions of the Plumbing Code of the City of
m Cupertino, and all other laws appli I hereto.
LL Use of Premis ,
00 �
oa Owner o Address�/�Slh�S
ZJ
By " ' Address
3 0 CONTRACTOR, A6Et
— � Phon �✓ S
aState License Approved
U PLUMBING INSPECTOR
FiXTURES NUMBER MAIN DRAIN
UNITS -PEES 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
Comb. Sink N Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Materia /o96
'I-
Sand Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
5prloklcr valvesI Water Sys.1 Fee /-
Permit Fee'
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough._
Partial Rough.,
Rough. Complete.. I
Main Drain -j
Final...