1824 { 1 Z- • T C YT � LOT NO! ` `-/
No. a i
D APPL A W FOR PLUMBING PERMIT
IV OCT 101962 1TY OF CUPERTINO
O�Se� —OF CUPERTW, 1�Z Permit No. 2
I Fee $
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 laws applicable thereto.
aUse of Premises
Owner AddressW
By AddressCONTRACTOR, AGENT
Phone.�1�1( — 3 7 'Approve
PLUMBING INSPECT
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater I eo I Size
Water Closets I &0c, Material C.G
Bath Tubs I/, ) II To Curb I
Showers / /�ya I To Prop. Line I
Lavatories I , Oo To Existing
Kitchen Sinks h. e o No Con fj z
Dish Washers I / SEvIER BO I 00
Waste Disposals / I
Wash Trays I I STORM DRAINAGE
Washing Machines,j / I/,p d II, Size
Wate( Softeners I I Material
Bar Sinks To Main Drain _
Comb. Sink a Traysl 1 II To Curb I •,---4-
Dental Units
Drinking Fountains) I II
Floor Drains II WATER SYSTEM
Hoppers I I I Size T
Restaurant Sinks I II Material C C- I I
Sand Traps TOTAL FEES
Urinals I Fixture Fee ;-O' b
Area Drains I Main Drain Fee ,;jr 00
Water Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee I / r/m'0
Permit Fee jjj 0 0
91.!iO4
TOTAL I TOTAL FEE /g, .B c)
RPOID) OF INSPECTIONPartial Rough �Rough Co toPFinal -
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