51133 (4) 30eG 9 • LOT NO.
NO, STREW'
ION FOR PLUMBING PERMIT
< � Y OF CUPERTINO
z2 D
w �
r p Sanitary No.
MAR 10
o < U, 196- ( Permit No
3LL Pee $ 7aO
o
71a, c�'}[is i i TjN t Ie City of Cupertino for a permit to install plumbing
o a pit, I d/. fixt t I reverse side hereof, and agrees to install said prices
r I 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.
P
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0 �. Use of Premises
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Oa Owner U o v Address— �
C���a"Cr f7A,r /041
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By �io—�1 Address
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CONTRACTOR, AGENT �^�` ,
Phone
a State License 23 o ! Cl Approved
a U PLUMBING INSPECTOR
FIX I URESNUMBER
UNITS FEES UNITS FEES
'Muter Heate Size
Water 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 . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Trap ,� TOTAL FEES
Urinals /�y, Fixture Fee
Area Dr ins Main Drain Fee e2
Wail o-p Storm Drain Fee
Spdnklcr lf.l,es Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 7
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Completr
Main Drain
Final