51145 (2) •I�I /��,�/I/(� R LOT NO.
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lkA, 1 OR PLUMBING PERMIT
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< Date CITY � 196—L V Permit No //
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OF CUPERTINO Fee 5 �/7/- --
2
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 priors
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all o er aws applicable eher fo.
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Use of emises C/Vt 117 .
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Address
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O CONTRACT R, A NT
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W W /u E Stale Livens Approved
c U� PLUDIBING INSPECTOR L
FIXI URESNUMBER
UNITS FEES UNITS FEES
`Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers I Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Coater Softeners / Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Arca Drains Main Drain Fee
Vater Leaders Storm Drain Fee _
Sprinkler Valves Water Sys. Fee
Permit Fee r�
TOTAL .;, TOTAL FEE yr
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
'.Main Drain
Final