100173 (2) NO. STREET O
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® �' L TION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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W Sanitary
Y S:Inita ry NU.
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O a Date S 196 Permit No./
3 LL Fees 3. 3�
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� Application is hereby made to the City of Cupertino for a permit tp install plumbing
o < pipes and/or fixtures listed on the reverse-side hereof, and agrees to install said prices
r and/0r fixtures m accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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j LL Use of Premises
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ao State License .23 / �GL— Approved'/'
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PLUMBING INSPECTOA
VIX109175'— NIJIMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets' C 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
Comb, Sink s Trays To Curb
Dental Units
Drinking Fountains
T-10-0r- Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee / 5-
Area Drains Main Drain Fee
1� ater Leaders Storm Drain Fee
Sprinkler valvesWater Sys. Fee
Permit Fee a2, d c+
TOTAL TOTAL FEE 3, 3--0
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...