1009 �O"DO i L/L ^�t (/ ✓"r/ .��, LOT NO.
NO. S ET
"APPL�C'iflbN FOR PLUMBING PERMIT
t:CITY OF CUPERTINO
' Date �— , t9�� Permit No.
Irl CITY OF CUPERTINO Fee $ ZO 06
Application is hereby made to the City 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
\ Cupertino, and all other lawns applicable thereto.
Use of Premises
'a"
0 OwnerO/[//r�a> /Lt�c�^ Address-
By—Z2<
sByAddress'
CO ACTOR, AGENT
�_ Phone -S/ - ApplOge PLUMBING INSPE ORS
FIXTURES NL,rfBE�R �i •a, , MAIN DRAIN
uNtrs£I`e;•• �I'l =;_-' IUNtrSI eccs
Water Heater / i,I '[ ,; ill"''Size '
Water Closets z_I q 3Material I l
Bath Tubs To Curb I l
Showers' I To Prop. Line
Lavatories / �Il I To Existing
Kitchen Sinks / Il Not Conn.
Dish WashersI � I SEWER BOXES
'Waste Disposals - { I
Wash Trays t ;t ;l lI " STORM DRAINAGE
Washing Machines / _ l Size
'Water Softeners Material l
Bar Sinks , , . „ I To Main Drain
Comb. Sink &Trays 1. ll To Curb l l
D-ental Units
Dunking Fountains) l _
Floor- Drams I WATER SYSTEM
Hoppers I I Size
Restaurant Sinks I it Material
Sand Traps I l II TOTAL FEES
Urinals - I I Il Fixture Fee
Area Drains I I Main Drain Fee
Water Leaders I I Storm Drain Fee I
Sprinkler Vaives I I Water Sys. Fee
Permit Fee o 0
TOTAL F O l TOTAL FEE p. p o
R CO DO S ION
Partial Rough /e
Rough;. in tete
Finalb'. ' '�