51133 LOT NO.
NO APPLICATION FOR PLUMBING PERMIT
z a' CITY OF CUPERTINO
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o a Date � � t' 62 Permit No .r
f APR 1 9967 Fee $
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
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and/p. ��ixtures in T �]a provisions of the PlumbingCode of the Cit of
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State Lice T T �/ y Approved
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n I PLUMBING INSPECTOR
FIXTURES IstR MAIN DRAIN
UNITS FEES uNrrsl FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Si Not Com.
is Washers I Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb.Sinks Trays To Curb
Dental Units
Dri ing Fountains
F oor Drains WATER SYSTEM
oppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urina s Fixture Fee
rea .rains Main Drain Fee
ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
:Plain Drain
Final .
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//-0/40 ' `+'� LOT NO.
ho. SIRE
APPLICATION FOR PLUMBING PERMIT
z ` CITY OF CUPERTINO
Z
Y o Sanitary No.
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aFee$ ✓ .s o _
0 ApkJtiq� hefeby�g a8e t e•City of Cupertino for a permit to install plumbing
o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
a and/or fixtures in accordanc % j�e revisions of the Plumbing Code of the City of
a w Cupertin6;.fand�.�I ' jI( Ic hereto.
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5 Use of Premises
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o State Licaa �y30 Approved '/
U PLUMBING INSPECTOR .4/
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FIXTURES NU,%113tR AIN DRAIN
UNITS FEES UNITS FEES
'Vater Heatc Size
W—ate—r —closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers 11Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
Water So teners Material
Bar Sinks To Main Drain
Comb. Sink&Trays To Curb
Dental Units
Drin ing Fountains
Tom Drains WATER SYSTEM
uppers ize
Restaurant Sinks Material
San 'taps TOTAL FEES
rina s Fixture Fee
tea rains Main Drain Fee
meter Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'blain Drain
Final