51006 2z 0-0 l / /Il V/ eu;S LOT NO.
NO.
I FOR PLUMBING PERMIT
" a D I OF
CUPGRTINO
x - FE •. �J Sanitary No.
x .
° / / 00
o a Date b 196— Permit No
.LL CITY OF CUPERTINO Fee S
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o < 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
<w Cupertino, and all other laws applicable thereto.
w 2
< S
j a Use of Premises
00
50
1411
3 Owner Z- /�/Address 0
oz z By d eG / Address-
Phone.
ddress
_ o
z Phone
< te License( / proved-
2
-U CONTRACTOR, AGENT
];IxIUHFS NUMBERI R I
UNITS FEES UNITS FEES
Water Heater 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
'slater Softeners Material
Bar Sinks To Main Drain
Comb.Sink % Trays To Curb
Dental Units
Drinking Fountains *70
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
Sprinkler V:iives Water Sys. Fee
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough Complete..
\Iain Drain