1159119,7
9 I ' LOT NO. .
N
O. J0 T
D AP N FOR PLUMBING PERMIT
JUL 7 W ITY OF CUPERTINO
�Q�t 195_ Permit No. //M-9
�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.
P Use of Premises
'4
v
Ow r Address
By Address
OR, GENT
Phone!N C3 Approved
�//1 O PLUMBING INSPECTOR
SURES NUMBER--F—MAIN
DRAIN
I UNITS I FEES II
1UNITSI FEES
Water Heater Ij
Sae j
Water Closets
Material j
Bath Tubs
j To Curb
j
Showers j I I
To Prop. Line
j
Lavatories
To Existing
Kitchen Sinks
Not Conn.
Dish Washers j
Waste Disposals II
I I
Wash Trays
STORM DRAINAGE
Washing Machines
Size I j
Water Softeners
I Material j
Bar Sinks
I To Main Drain j
Comb. Sink a Traysl
To Curb
ii
Dental Units I
Drinking Fountains] j
Floor Drains j
WATER SYSTEM
Size
ze
Restaurant Sinks j
II Material
Sand Traps I
II TOTAL FEES
Urinals j
jj Fixture Fee
Area Drains
Main Drain Fee
Water Leaders j
I Storm Drain Fee
Sprinkler Varves j
II Water Sys. Fee j
§]EWER BOXES
I :Permit Fee
TOTAL I
II -TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final 1