51125 (3) / I J LOT NO. •�/
NOVAUG
Q F.F
R PLUMBING PERMIT
N CUPERTINO
12 Sanitnr No.
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Dat C� ' `� 119 Permit No ✓�47D
5U U
Pee $ �7
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 I 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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j Use of Premises . 'T /�
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O C^04�T/RACT A AGENT
3 0 Phone
¢ State LiL- 20 I Approved
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PLUMBING INSPECTOR
FIXI URES
UNITS FEES UNITSF FEES
Water Heate Size
Water Closets Material
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
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Materially'
San Traps TOTAL FEES
Urinals Fixture Fee 000
Area Drains Main Drain'Pee �y0
mater Leaders Storm Drain Fee '
�prinklcr Valves Water Sys. Fee dra
Permit Fee t Grp
TOTAL pp TOTAL FEE G
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
:Main Drain
Final