51039 (2) / /— 7 / I LOT NO.
NO. STREET
y�APiLIC�`A,�,IN FOR PLUMBING PERMIT
i a .�� �'1.�r3 I OF CUPERTINO
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r o Sanitary No.
o a Date - JUN ] ; 6 6� Permit No �l /l U '3%
3 LL Fee $
Ile do h t City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures liste on t e reverse side hereof, and agrees to install said prices
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1- and/or 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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a Use of Premises
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3 Owner Address
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0 CONTRA TOR, AGEN
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ne �t_'S —�99�
a o State Licensee Approv
U\� PLUMBING INSPECTOR
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171XTURES DBLR MAIN DRAIN
UNITS FEES UNITS FEES
`7Vatcr Heate Size
Water Closets boo" ,AO Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories a op To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was—Trays STORM DRAINAGE
Washing Machines ✓ Size
Dater Softeners _ Material
Bar Sinks To Main Drain
Com . Sink a 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
VVater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee %�—
Permit Fee „Z
TOTAL TOTAL FEE 6
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .