100042 (5) o?oo z/ ,�,&�
LOT NO.
NO. S E8
T FOR PLUMBING PERMIT
a OF CUPERTINO
x o fUL 9 1985 Sanitary N0.
LL
yd
3 0 /OD�
< Date — � 196.E Permit No
w LL CITY OF CUPERTINO Fee s
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� Application is hereby made to 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
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fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
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w = Use of Premises
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3 Owner Address
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$y.�G. i/ Oi Address
CONTRA OR, AGENT
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ao State License 9s/ !� Approved CyU���[n roc ✓ � .
PLUMBING INSPECTOR
FIX I URES NUMBER
UNITS FEES UNITS FEES
Water Heate / ° Size
Water Closets Material _
Bath Tubs ez
To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
'Was-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink x Trays To Curb
Dental Units
Drinking Fountains
door Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sa.cT Traps TOTALFEES
Urinals Fixture Fee 6 oz
rea Drains Main Drain Fee 6,VZX/ater Leaders Storm Drain Fee
Jprinklcr VolvosWater Sys. Fee o-p
Permit Fee t�
TOTAL uv TOTAL FEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...