1152 OLor No.
NO.
F
111� S
APPLICA�1��1 FOR PLUMBING PERMIT
j 22 OF CUPERTINO
Date.
Dat4_1 Permit No. I I tl
Fee $ "m
' Application is hereby
urmade to the'City of Cupertino for a permit to install plumbing
pipes and/or fixtes listed on the reverse side hereof, and agrees to install said prices
and/orfixtures4in�accccordance with the provisions of the Plumbing Code of the City of
perrhno, andall other laws applicable thereto. 1
Use of Premisese
u ' 1 //v >
Owner LEI-) f�'/¢��� Address D O U�
By Address i' D
qnrroxnnexr
hone Approvei !�— �, PLUMaI G INSPV56T
FIXTURES NUMBER MAIN DRAIN
UNITS FEES 11 IUNITS I EES
Water Heater Size j
Water Closets j �j Material j
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing j
Kitchen Sinks Not Conn. j
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines _ jl Size j
Water Softeners pp 11 Material
Bar Sinks j j jj To Main Drain j
Comb. Sink s TraysTo Curb
Dental Units
Drinking Fountains 1 1,1 j
Floor Drains I WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee . -9
Area Drains j Main Drain Fee
Water Leaders j j jj Storm Drain Fee
j �j Water Sys. Fee
Sprinkler Vatvcs !
Permit Fee , A
TOTAL j j/ ,jj TOTAL FEE 91
RECORD OF INSPECTION
Partial Rough
Rough Com
etc '
Final