2444 iOT No.
NO. Q EET
p ISALIN FOR PLUMBING PERMIT
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z < Y OF CUPERTINO
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r o 1963 Sanitary No.
LL
3 a Date— ' / 1962 Permit No.
w LL
CITY OF CUPERTINFees
O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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00 Use of Premises
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r 3 Owner�n-��"� U'�-e-� Address
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z By C =�G`7 -G Address
CONTRACTOR,AGENT
m Phone
ao State License 1 --2 7 a Approved
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J PLUMBING INSPECTOR
FIXTURES I R I
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Z 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
D,•;nt I Units
Drinking Fountains I
PIGor Drains WATER SYSTEM
H'uppers Size
Restaurant Sinks Material
Tai Traps TOTAL FEES
Urinals Fixture Fee
Arca Drains Main Drain Fee Z
Water Leaders Storm Drain Fee
5p17111 Varves Water Sys. Fee
Permit Fee ti
TOTAL TOTAL FEE
RECORb OF INSPECTION
Underground Rough... _
.Partial Rough.. -,3
.Rough.Complete.. // - 12-
Main Drain
Final---
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