2766 / OJ LOT NO.
NO. ' STREET'
D � L't N FOR PLUMBING PERMIT
ITY OF CUPERTINO
x o ��� Sanitary No.
C LL
o a Date L 196 Permit No OY`
3U
Fee
Cl Application i-sTiplgp liSeYb 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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all ther laws appli able thereto.
� r
LL Use of Premises
Ll"
O � -
Owner A ss
By Addres ONTRACCOR, A ENT
- 0PhonState Li r7 Approve
PLUMBING INSPECTOR
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i
UNITS FEES 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 Softeners7 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
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL :i TOTAL FEE _
RECORD OF INSPECTION
Underground Rough...
Partial Rough-
Rough, Complete..
Main Drain