51145 Plumbing Permitr 2/.SdG I 4� 14&- ter
OT NO.
NO. STREF.i' -
P CICA ON FOR PLUMBING PERMIT
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a ITY OF CIIPFRTINO
0 o (JAN 1. 3 19Eb Sanitary Nn.
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J Dae 196_ Permit No
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3 u r f k�6yttd til t� Fee $ �S
Clt>kicfitt on rsll er a 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
i and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other laws applicable thereto.
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Use of Premises
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o a Owner 7,)�e4. Address
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¢ a ? 90y07
a o State License Approved
PLUMBING INSPECTOR
Fri I URES NUMBER
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 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink u Truys To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee N
Water Leaders Storm Drain Fee
�prinklrr Valvcs Water Sys. Fee
Permit Fee lep
TOTAL TOTAL FEE Q
ECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final