2589 V?JJ _-- LOT NO.
NO.
oOM FOR PLUMBING PERMIT
d 1I OF CUPERTINO
r 0 ,1FEs 211964 '�, Sanitary No.
0 j
0 Date , 196_ Permit No CPS
LL
W IT� OF CUPER! '.'" Fee$ �n
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A 'Idle tion is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all
otther• laws applicable thereto.
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LL Use of Premises �` 4' a �`�'W ' Fed—
00
3 Owner ' Address
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z,` By Address /l 0
O CONT OR,AGENT
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� a /a � (o lO
a o kState License Approve
U PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size (It Q
\Vater Closets c Materia /jyx
Bath Tubs To Curb
Showers To Prop. Line
Lavatories a O To Existing
Kitchen SinksO°_ 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 Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee B-9—
Water Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 7,2c
RECORD OF INSPECTION
_Underground Rough_,. -
Partial Rough..
Rough. Complete.. -7-
'v'Iain Drain
Final...
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