51145 �/// I nK/VYW' ✓��0 LOT NO.
NO. STRE
A PI�Ajjl OR PLUMBING PERMIT
T r CUPERTINO
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x o � 1 j 1967 Sanitary No.
0LL „(/X ST// S S
o J lJate � 196 Permit No_
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W a }} T�b�r i Ti� "tl�tid'ib`thN. yt• p Pec i J
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A >>h a i n a reby t 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
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in and/or fixtures in ac rdance with the provisions of the Plumbing Code of the City of
a w Cupertino, and al otheraws applic e heret8.
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a Use of ises
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aState Lice frYL7y Approved `
PLUMBING INSPECTOR i
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PIX J
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
Was TTrays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . 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 (�
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys.. Fee
Permit Fee (J
TOTAL TOTAL FEE 'D
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final