51145 (3) J(+ LOT NO. r ,I,?/
NO. TIiEEI'
ft?aI FOR PLUMBING PERMIT
z < D (1[ OF CUPERTINO
rI�IMAR 17 1966 SanitaryNo.
4
o � IJate 196_ Permit No
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_ Fee $
W ,4IiTY QF eWT)NP
° A i a ion her o 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws a plicable they to.
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0 Use of Premises
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,- 3 Owner �/ Ji Address-
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f State LicensL-36 Z.3o $' 07Approved t'
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0 PLUMBING INSPECTOR /
FIX I UREb
UNITS FEES UNITS1 FEES
Water HemSize
Water Closets 3 Material
bath Tubs To Curb
Showers ! To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers / / Sewer Boxes
Waste Disposals r
Wafh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks i To Main Drain
Com . Sink v 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
Water Leaders Storm Drain Fee
7-prinkler Valves Water Sys. Fee
Permit Fee
TOTAL / y 1 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final