51066 LOT NO.
h0. STRF,F.I'
PEJA N FOR PLUMBING PERMIT
` TY OP CUPF.RTINO
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r O _ I 5 OCC Sanitary No.
¢ LL JUO
o Date 196 Permit No
3 ` 3
Fee
O CkT lic.hlbn isMtPthl RTJ( Dthe City of Cupertino for a permit to install plumbing
o a ' pipes and/or fixtures listed on the reverse side herrn[, and agrees to install said prices
> 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. A
4 Use of Premises
oa OwneM.�4LC 42fl Addres9 4-1
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F B CONTRACTOR, AGENT Address
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Phone,
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a o State License Approved
U PLUMBING INSPECTOR
I 1
UNITS FEES UNITS FEES
'JVater Heate Size
Water
C osets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposa
as71 Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant SinksMaterial
San raps TOTA EES
Unna s Fixture Fee
rea rains Main Drain Fee
�t/t—kVLeaders Storm Drain Fee
Sprinkler Volvos Water Sys. Fee
Permit Fee a�
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final