Plumbing Permit LOT NO.
NO. 5TR EP.T
N �APP�[CATI, fNrFGR�PLUMBING PERMIT
z CITY OF��UPERTINO
j 103 1968 sanitary No,
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0 a Date / ,� 196_ Permit No
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x `o �"7V nr7 P-PI nTNA() Pee S
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LL w Application is reby' made to thetCity'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
and/or fixtures in accordance with the es' ns of the Plumbing Code of the City of
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provCupertino, and all other laws applicable thereto.
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w Use of Pr ises
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3 Owne Q Addres
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2 By Addr�sP`� CC MA f '
NTAA OR, AGENT
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— � Phone
a o State License �'`��da Approve
U PLUMBING INSPECTOR
Z
HX I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
`.Cater 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
'Waslh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Arca Drains Main Drain Fee
�/� ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee _
Permit Fee _ o'-7
TOTAL TOTAL FEE yds 3D
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final._