2579 NO. EE
O. Q OOR PLUMBING PERMIT
CI P CUPERTINO
r IJAN 2 8 9964 sanitary No.
0
3 a Date 196— Permit No '
CITY OF CUPERTINO Fee $
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 prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and other law�,liiccaabble thereto.
o_ o Use of Premises
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o FNTRACTOR,AGENT �N
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d 4 �/ ,3 3 i/ ��3G� Approved
a o JSTate License
rt_U PLUMBING INSPECTOR
.XJ
RWashers
UNITS FEES UNITS FEES
Water Hate � .� Size
r Closets Material
Tubs To Curb
ers To Prop. Line
ories Z To Existing
en Sinks Not Conn.
Washers Sewer Boxes
Disposals Trays STORM DRAINAGE
ing Machines Size
r Softeners Material
inks To Main Drain
. Sink s Trays To Curb
Dental Units _
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee Q
Area Drains Main Drain Fee 00
Witer Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
R ORD OF INSPECTION
Underground Rough_. —3p- _
Partial Rough.. —fid
Rough. Complete.. '
Main Drain
Final... �� —30 _