1008 NO.
NO. EEr ry
AJJP.P��L`I�C�ATION FOR PLUMBING PERMIT
CITlY CUPERTINODate VJAN 6 11%X'
Permit No.
CITY OF CUPERTI Fee $ `
Application is hereby made to the Ity of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of - d
?t Cupertino, and all other laws applicable thereto.
Use of Premises �/r:�.�/��d 1 -a - �`• -Z e,
Owner Address
By AddressI'
Phone -os/f� Approve *
w PLUMBING�E` OR�X
� V
FIXTURES NUMBER MAIN DRAIN
UNITS FEES IUNITS I FEES
'Water Heater Size
Water C osets " I / Material
Bath Tubsc-.e I � I II To Curb � I
Showers To Prop. Line, L'
Lavatories Ali/ To Existing"
Kitchen Sinks `IPF/ II Not Conn.
Dish Washers IISEWER BOXERI I
Waste Disposals 11 r I
ash
"shYTrgy
s s11 STORM, DRAINAGE
t.4filachines / Size -
it-e So6Pe'ners • I Material
Bar'Sinks' To Main Drain
Comb. Sink a Traysl 1 II To Curb
Denta(,Units
Drinking Fountainsl II
Floor,Drains WATER SYSTEM
Hoppers` Size
Restaurant Sinks Material , A
Sand Traps TOTAL'FEES:'- _ .qW
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders *."p' Storm Drain Fee aY-
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL V1 TOTAL FEE
RECORD TION
Partial Rough
,Rough Complete
Final /