51064 PLUMBING—FIXTURES ___-NUMBER
I
UNITS
FEES
UNITS
FEES
Water Heate
Size
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
w2_0
Area ins
Main Drain Fee
a
Sprinkler_.Y.Jves
/ fto
Storm Drain Fee
Water Sys. Fee
TOTAL
/
Permit Fee
TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough: Complete
:Main Drain
Final
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LOT NO.
NO. ISTREET `
APPLICATION FOR PLUMBING PERMIT
® TY OF CUPERTINO
Sanitary No.
Da . 196� Permit No
Fee $
Application is h re e City of Cupertino for a permit to install pluribing
pi TiY�c roRi e r i reverse side hereof, and agrees to install said prices
an or xtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises �E�S �JG�C --57 / d �� ej <-:�)—
Owner f
CCAAACTOR, AGENT
Phone Z 5 I 3(�0
State
/License'209Z 2
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