1495 /O! LuC. lY4G� ✓n• LOT NO. ,
NO. STREET
DON FOR PLUMBING PERMIT
111 r� TY OF CUPERTINO p
Date „ L D 4:2Permit No. / 7
CITY OF CUPERTly Fee $
Application is hereby ma e o 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
r Q and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and allr laws applica le ereto.
D
Use of Premises
:a
ti Owl fi' ' Addres
4, /Address'
Phone � Approve
PLUMBING INSPECTOR
_ 1
FIXTU-- NUMBER MAIN DRAIN
UNITS FEES UNITS +M
Water Heater I Size
Water Closets Material
Bath Tubs To Curb 11
Showers To Prop. Line ._Io
Lavatories 'lo Existing 'I,
Kitchen Sinks Not Conn. _�.; _
" Dish Washers �� r
Waste Disposals 7
'Wash Trays STORM DRAINAGE
Washing Machines
Water Softeners t Material ]
Bar Sinks To Main Drain
Comb. Sink &Trays To
Dental Units 11
Drinking Fountains �I
�
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps 11 TOTAL FEES
Urinals Fixture Fee I
Area Drains �� Main Draintfee
Water Leaders `Storm,,fain Fee
Sprinkler Valves '`�� Water SyS. Fee
Permit Fee fl
TOTAL TOTALFEE A
RECOR OF INSPECTION
Partial Rough T
Rough Complee
Final
G �