2712 .� •I .v /�//.�P� LOT NO. ZZ
NO. Q T77A ION FOR PLUMBING PERMIT
ECITY OF CUPERTINO
xp ' APR 27
° Sanitary No. _,
p°w w Date 196iu
Permit No.
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LLCiF
CIIRERT 1; • Fee $
° 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 a and 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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w Use of Premises
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aa Owner Address✓:/6 � . u.>n �
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° CONTRACTOx,AGENV
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ao State License . Approve
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PLUMBING INSPECTOR
TN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Ware, Closets Material
Bath Tubs To Curb
Showers , To Prop. Lin
Lavatories To Existing
Kitchen SinksNot Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines j,.,201Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units .
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers - Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee ,
Area Drains Main Drain Fee ,
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee Q
Permit Fee :W'a9
TOTAL TOTAL FEE
REWED OF INSPECTIO
Un erbroun aug �/�
.Partial Rough-
.Rough. Complete.. -
\lain Drain
Final...