51117 (3) �O 19 I LOT NO.
NO Q F. 7
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® PtY 'I1TIFOR PLUMBING PERMIT
z a SEC OP CUPERTINO
xofP 24 1965 sanitary No.
¢ 4
o Date *,IRB— Permit No
3 CITY IVU a
a Pee $
o Application is hereby made to 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
a w Cupertino, and all other laws applicable thereto.
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Use of
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r. 3 Owner Address
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CONTRACTOR, AGENT
— � Phone
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a o State License Approved
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-U (uf PLUMBING INSPECTOR
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—FIX I URES
UNITS FEES UNITSI FEES
Water Heate Size
Water Closets / Material
hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
TV"as7 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
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee OG
Area Drains Main Drain Fee
Nater Leaders Storm Drain Fee
Sprinkler Vatves Water Sys. Fee
Permit Fee o0
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final