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" [ APRUCAI I 111FgRNPLUMBING PERMIT
.W i i CITY OF;, UPERTINO
xo 1JUL 221968 I�� sanitary _
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0 f Date 1' b -1^� , .} Permit No f 7 1
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3 LL �! ; `' ti!?�4TI,10 Fee s /S s
o 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
I 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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4 Use of Premises
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3r CON'ERACI'OR,AGENT O
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Phone .� .y2 QO-7-7b
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a o St. e License 1-!13 i - Approved
PLUMBING INSPECTOR /
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FIXTURES DBER MAIN DRAIN
UNITS FEES UNITS FEES
`.Vater Heate � Sl7 Size
Water Closets �, 3 p Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories .30o 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
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
pCrb u I Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee p ,O 0
Area Drains Main Drain Fee
ZXrater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
RS l t1 I Permit Fee ry Q D
TOTAL 3 p TOTAL FEE S,,
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final