989 1J A ��r - �L7 ��+� LOT NO.
NO. STRBE
FOR PLUMBING PERMIT
�V 4p OF CUPERTINO ' �nry }/(y
Date / U 1 � Permit No. ( u
CITY OF CUPERTINO Fee$ / s�
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 oth�c Lws applicable thereto.
Use of Premises
A Owner 0' - Address
b
C , E
_ Address
OT
PhonApprove
PLUMB
IG INSP
F17FURES NUMBER MAIN DRAIN
UNITS I FEES IUNITSI FEES
Water Heater i Sae
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks �� Not Conn.
Dish Washers SEWER BOXES
Waste Disposals �I I
Wash Trays STORM DRAINAGE
Washing MachinesSrze
Water Softeners Material j
Bar Sinks' To Main Drain
Comb. Sink s Trays To Curb �
Dental Units _
Drinking Fountains) �I �_
Floor Drains WATER SYSTEM
Hoppers Size
Restabrant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
_Sprinkler Vaives I Water Sys. Fee
A Permit Fee
TOTAL 1 . 0 II TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Com 1 e
Final