51145 (3) [/1 I✓c� O. I / I! LOT NO. �O/
NO. _/✓ F.ET
=LUXT FOR PLUMBING PERMIT
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','G�l� OF CUPERTINO
i ¢ Sanitar Nu.
o < oat 41966 196_ Permit No
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° aT ti(0Fs hGWrERT1NG 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 other laws applicable thereto.
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a 4 Use of Premises
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ao State License Approved i , /
�l PLUMBING INSPECTOR `, -
FI? MBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcate Size
�17—
Wate, 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
Com . Sink ,% Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size `
l"
Restaurant Sinks Material L
San Traps TOTAL FEES
Urinals Fixture Fee e�
Area Drains Main Drain Fee _crJ
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 11,
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final