51037 (2) r
/a60 �a�t � ��s /� LOT NO. dpiNO. S
® .SPT DTII FOR PLUMBING PERMIT
�1FL5 OP CUPF.RTINO
W 0 6 1965 ��' Sanitary No.
4Siaj
3 a Date 96�: Permit No
=LLCITY OF CUPERTI Fee $ ��
O Application is hereby made to the City of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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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a Use of Premises
00
3 Owner Address
i� f _
Z By / Address
y CONTRACTOR AGENT
30 Phone
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< State Licensr, �36_ll�i�y �
Approved
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PLUMBING INSPECTOR
IX R ; IN BER II R I
UNITS FEES UNITS FEES
Water Heater Size
Wate; Closets MaIcnal
Hath 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
'�C/ater Softeners Material
Har Sinks To Main Drain
Comb. ,Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM'
Hoppers Size
Restaurant Sinks Material
Sand 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..
\lain Drain
Final...