51064FIXTURES NUMBER
MAIN DRAIN
UNITS
FEES
UNITS
FEES
Water Heater
I
�I Size
Water Closets
I
I
�� Material
Bath Tubs
I
To Curb
Showers
To Prop. Line "
Lavatories I
I
I� To Existing
Kitchen Sinks
Not Conn.
Dish Washers I
i�
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
I
I
II Size
Water Softeners
Material
I
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
I
��
Drinking Fountains)
I�
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
l'
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Valves �I
I
II Water Sys. Fee
Q3,
Permit Fee
,-2-
TOTAL
TOTAL PEE If
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final
22086 1 Oakcieil PJ 2da LOT NO.
NO. STREET
RLTION FOR PLUMBING PERMIT
Ty OF CUPERTINO
Da "' 195�5 Permit No.
I�l�R
II ((�� D[� pp Fee $ 4.00
4TYlicaff, i TANDthe City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises 'a vla C.,
O� yean
A r
By
CONTRACTOR, AGENT
Phone 967-4545
Address 22088 Oakdell Place
Address 243 B Moffett Dlv.
Approve
PLUMBING INSPECTOR