100089 i 975 2
NO. STREET
® IC FOR PLUMBING PERMIT
z a ci•�`� OF CUPERTINO
r ° /MAY 2 Sanitary No.
0 ' Date 4 1966 6_ Permit No/0C) O sl
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� A do s h T� permit to install plumbing i
o a pipes and/or fixtures listed on Elie reverse City of Cupertino for a side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plum g Code of the City of
<w Cupertino, and all oth ws applicable th eta
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Use of Premise
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CONTRACTOR, AGENT
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3 uQi Phone 36 9-
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a �/V to LicenseC"/6 f'/174 60 9 Approve
PLUMBING INSPECTOR
HXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Herne 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
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units.
Drinking Fountains
Floor Drains WATER SYSTEM
oppers Size
Restaurant Sinks Material
Sand raps TOTAL FEES
ring s Fixture Fee
+`'r'ea rains Main Drain Fee
Water Lea rs Storm Drain Fee
Sprinkler S Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Slain Drain
Final