51122 (2) /O 3 t '
APPLICAI FOR PLUMBING PERMIT
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Q CT 2 6 1965 TY OF CUPF.RTINO
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� Application 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
> . 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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Use of Premises �' C,
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f State LicenseXX I,11C/I Approved -G
Qo�-u PLUMBING INSPECTOR /
FIXTURES
UNITS FEES UNrTS FEES
Water Haate Size
Water C osets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
ante Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink urays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San ra s TOTAL FEES
al / Fixture Fee
Area Drains / Main Drain Fee
W/�er Leade Storm Drain Fee
Sr, a / Water Sys. Fee
V. Permit Fee
TAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final