51145 (3) yp /— � LOT NO.
NO.
STREET
Pls ► ON FOR PLUMBING PERMIT
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Z �,�j,y Y OF CUPERTINO
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o a I,a APR 4 1966 , 196_ Permit No
3LLFee .S�6 DU j
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City of Cupertino for a permit m install Plumbing
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the reverse side hereof, and agrees to install said prices
r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws app icable theret .
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n Use of Premises
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Address
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0 R State License ��� / �� Approved �
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—0 PLUMBING INSPECTOR
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FIXTURES M
UNITS FEES UNITS FEES
'Nater Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories _ `j 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 . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee / ��-
rea Drains Main Drain Fee ,Z✓'�--
Water Leaders Storm Drain Fee
9p rinklcr Vales Water SyS. Fee /
Permit Fee a O o
TOTAL77 TOTAL FEE G O
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final