51145 (3) 7.1c.01 I LOT NO, ci
NO. STREF.
Nd �? A Ll* I FOR PLUMBING PERMIT
fAPR OP CUPERTINO
xo 22 1966 sanitary No.
0 Date , 196— Permit No
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3 w CITY 01 Cf 1ebyP �,�I�,l Pee S��
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Application is herto e City of Cupertino for a permit to install plumbing
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0 : pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
rI and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws , p cable to.
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3 Owner Address
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W i Phone 7
w w State License 273 �'S'y 7 Approved /
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_U PLUMBING INSPECTOR
IX I URES NUMBER
UNITS FEES UNITS FEES
Water Heate SiteY-A
Water' Closets Material C,
bath Tubs To Curb
Showers To Prop. Line
Lavatories 3 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 v Trays To Curb
Dental Units
Drinking Fountains
1=loor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks I Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
'Iain Drain
Final