1684 Lot NO.
NO. 0 BB
D PLICA 0O PLUMBING PERMIT
UG 3 1962 C F CUPERTINO
Date Permit No.
Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
Q 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
`JvR Cupertino, and all o laws applicable thereto.
u
O
Use of Premises i
'a
owner 1 n Address
By 9+'s Addr
co o , neea{�
Phone . i) O Approve
PL MBINOINSPECTOR
I URL$ MB M INTF
RAI
UNITS FEES �� _ �UNITSFEE;
Water Heater I I Siae-�T
Water Closets Material
Bath Tubs �� To Curb
Showers it Tu Prop. Line
Lavatories �� To Existing
Kitchen Sinksj Not Conn.
Dish Washers j
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines S1ze
Water Softeners Material
ar mks- o Main Drain
Comb. Sink e Traysi To Curb
Dental Units ��
DrinkingPountains� �I
Floor Drains WATER SYSTEM
Hoppers l 1LSize 11_
Restaurant Sinks Material
Sand Traps TOTAL FEES
'
Urinals �� fixture Fee r O
Area Drains Main Draih Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee r#00
Permit Fee .04
TOTAL TOTAL FEE ZJ D b
R CORD OF INSPECTION
Partial Rough
Rough Complete
Final