2459 LOT NO.
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L'tC N FOR PLUMBING PERMIT
CITY OF CUPERTINO
r oVCT 22 1q Sanitary No
LL
0 a Date �7-- 196 Permit No
3 CITY OF CUP IRT�,��^ Fee $ S
0 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
r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<m Cupertino, and all other laws applicable thereto.
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LL Use of Premises
00
o3: �wner C. S (t9l�r Address
ou—�By � r2.. Address
3 P CONTRACTOR, AGEN3 ^
— <0 Phone L-r�
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a2 State License -Approved F 7
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JqXTURES NUMBERMAIN I
UNITS FEES UNITS FEES
,Water Heater Size
Water Closets Materia!
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
SanTTraps TOTAL FEES
Urinals Fixture Fee D C1
AreaDrains Main Drain Fee
Wat Le ,r, Storm Drain Fee
spri Valves Water Sys. Fee
AT -C i— O'O Permit Fee uO
AL 0 ( TOTAL FEE UU
RECORD OF INSPE TION
Underground Rough. _,30_3
.Partial Rough..
Rough. Complete..
\-Iain Drain
Final...