51001.3 A �� LOT NO. .�
NO. STREET
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OR PLUMBING PERMIT
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0 < Date FEB 2 J 196$ Permit No
+ Fee $ �
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0 App(t+a�{ t i( reBy 9 the ity of Cupertino for a permit to install plumbing
`o a pipes andJJor fixtures listed on the reverse side hereof, and agrees to install said rices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<W Cupertino, and all other laws applicable thereto.
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UNITS FEES UNITS FEES
Water Heate S1Ze
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Des Washers Sewer Boxes
Waste Disposals_)
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s, Trays To Curb
Dental Units
Dnn ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size /�' /
Restaurant Sinks Material ,aLv
San Traps TOTAL FEES
Urinals Fixture Fee' `„SU
rea rains Mai rain Fee - OL
WaterLeaders Fee f0
Sprinkler Valvcs Water Sys. Fee j Q
Permit Fee
TOTAL TOTAL FEE a _ p
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
\Lain Drain
Final...