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OT NO.
NO.' V STNEF.T ^ i
® ON FOR PLUMBING PERMIT
N Q
z 4 QTY OF CUPERTINO
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Y O 1 �' `3 �� Sanitary No.
o Date 1965/ Permit No
3a ^'I T—
U 4UP E TI O Fee $
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CIL
° C�TRpp��tion is here y ma e 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
> and/or fixtures in accordance with the provisiogqs of the Plumbing Code of the City of
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Cupertino, and all ct er 1ws applicable et Cod
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j Use of Premises
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3Own Addres
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;jNTAAC L,'AGENT
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o s State LicenS�� / / J t'� Approved =INSPECTOR
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U�I PLUMBING INSPECTOR /
HX I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines a Size
Water &.i teners Material
Bar Sinks To Main Drain
Com . Sin r rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
mi
Hoppers Size
Restaurant Sinks -Material
San raps TOTAL FEES
rinals Fixture Fee f—
rea rains Main Drain Fee
W-ater Leaders Storm Drain Fee
�prinkl,, %1.1,n Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE p V
CORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final