1166 (2) LOT NO.
NO. STREET
A M&M
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ON FOR PLUMBING PERMIT
ITY OF CUPERTINO I r
o JUL 1819 _ 195— Permit No.
CUERTINO Fee $
CIAligiF on 'S herePby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plum ' Code of the City of
Cupertino, and all other laws.gpplicable thereto.
B Use of Premises 2
'a
N
Owner- t " ' ' 'A V 1 Address=
Address
NTRA
COCTOR, AGENT
hone "�- L'.Cj`� t�\ Approve
PLUMBING INSPECTOR
TURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Sae
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water•Softeners Material
Bar Sinks To Main Drain
.Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains) 1 1!
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material I I
Sand Traps TOTAL FEE
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
SprinklerValves 6h) IWater Sys. Fee
ER BOXES II Permit Fee
TOTAL TOTAL FEE Si
RECORD O • INSP .CTIO 1
l
ial Roughgh Complete
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