51145 (2) 2� SOLI I "moo " Ad-1- i2A LOTNn. �ee;
NO. STREET
?PR
p P ,LI ION FOR PLUMBING PERMIT
�`T®� OP CUPERTINO
sanitary No.
oj Dat22 966 ,.196— Permit No
3 `
Fee $
° C] iY-tiQn�rs h,Sel�7� df f3,,fYI City, of Cupertino for a permit to install plumbing
o a pipes and/or Ixtures Iistedlon'�h reverse side hereof, and agrees to install said prices
I and/or fixtures in accorda • with the provisions of the Plumbing Code of the City of
a w Cupertino, and all oth laws app4calble thereto.
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0LL Use of Premises
00
3 Owner Address
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By Address
ON'V;
, /TOA• AGENT
3 Phone 7 7 ,5 y
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a o ate Liccnse,� Approved
—U PLUMBING INSPECTOR
FIXTURES 1
UNITS FEES UNITS1 FEES
Water Heate Size 1
Water Closets Material C,T
bath Tubs To Curb
Showers To Prop. Line
Lavaturies 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 s Trays To Curb
Dental Units
Drinking Fountains AM
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Materia
San Traps TOTAL FEES
Urinals Fixture Fee Ii
Area Drains Main Drain Fee L
Water Leaders Storm Drain Fee
�prinklrr vahes Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE •
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final