825 LOT NO.
NO. f STREET
�P N FOR PLUMBING PERMIT
OF CUPERTINO
01 19L 0 Permit No.
CITY OF. CU ER. INO Fee$ �---
Apphtation Is here�y-ma�e 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.
v
H Use of Premises
v o r
Ow dre
M a- A
H I-t • ' Address
CONTR�QCTOR, GENT `N:�' tl
Phon _ Approved
PLUMBING INSPECTOR .j
TURES I NUMBER 11 MAIN DRAIN
I'UNITS I FEES II 1 UNITSJ� FEES
Water Heater Size I,. ?1`L"M . r
Water Closets Material .I,_''.w„-•,�';
Bath Tubs To Curb h
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers I SEWER BOXES
Waste Disposals I�
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners aterial
Bar Sinks To Main Drain
Comb. Sink & Traysl l II To Curb l
Dental Units 1 11
Drinking Fountainsl I 11
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks l ll Material
Sand Traps TOTAL FEES
Urinals Fixture Fee ,
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vawes Water Sys. Fee
Permit Fee -
TOTAL OTAL FEE
RECO OF INSPECTION
Partial Rough -
Rough Compete
Final ` _ Q�