2739 i�ssy 1 BaonI LOT NO.
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D1 FOR PLUMBING PERMIT
ITY OF CUPERTINO
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r o `j y 21 1964 , / Sanitary No.
0 a Date / 1961V Permit No
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= o CITY OF CUPERTiND Fee $
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
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w= Cupertino, and all laws applicable skereto.
,. Use of Premises < <
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X E State Licen d Approved
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PLUMBING INSPECTOR
t. T ,
FIX I URES
_ UNITS FEES UNITS FEES
Water Heate Size
Water Closes 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
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee c�
Area Drains Main Drain Fee
W-ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /, 00
Permit Fee
TOT AL .p� TOTAL FEE p
I ECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete/ _
Main Drain
Final...