2655 (2) • 9�7i I v' ( gyp ,� /�L - LOT NO.
• NO. 0
D 10 FOR PLUMBING PERMIT
a CITY OF CUPERTINO
i o �►1 AR 191964 Sanitary No.
3 < Uate� ✓ — 196 ' Permit No.
CITY OF CUPERTINO Fee$ o
o Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N a,Application
fixtures in accordance with the provisions of the Plumbing Code of the City of
zw Cupertino, and all o r laws applicab a ereto.
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J O fS C OR,AGE Addres
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oo State LicenslC�'T J Approve
Q-IV /G5�C� PLUMBING INSPE
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—FIXTURES _
UNITS FEES UNITS FEES
Water Heate Size
Water Closets- Material _
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Uc- en Sinks NotConn.
DishWashers Sewer Boxes
Waste Disposals
a�U sh Trays STORM DRAINAGE
Washing Machines Size
�vger Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Efj
Drin ing Fountains
P oor-T Drains WATER SYSTEM _
opperFl s Size
Restaurant Sinks Material
San r�I aps TOTAL FEhS
renals Fixture Fee' 1. 0ci
Area Drains Main Drain Fee
Water Storm Drain Fee
Sprinkler Valvcs Water Sys: Fee ,p o
PermitFee 2 .0 0
TOTAL TOTAL FEE ,O 0
RECORD OF INSPECTION
Underground Rouigh... _
Partial Rough..
Rough. Complete..
Main Drain
Final._