855 LOT NO. _
�. O. Q I ET GN BF�i/fid.
&Ff!A
N FOR PLUMBING PERMIT
UG 3 TY OFF CUPERTINO
y 1907a Permit No.
U�ERTINO 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 th Plumbing ode of the City of .
??tt Cupertino, and all other laws applicable thereto_
uUse of Premises -./GLG�
n Owner — 7—Z /% ZAA Address J�
Addres
CONTRACTOA, AGENT �
Phone �L a o>9/ Approve
P"'a"G INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES I UNITS FEES
Water Heater Size - (-
Water Closets - �� Material
Bath Tubs To Curb '
Showers To Prop. Line -
Lavatories To Existing �.
Kitchen Sinks Not Conn. �. �..
Dish- Washers
Waste Disposals
Wash' Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays ..To Curb
Dental Units
Deinking Fountains _..;I • � i
Floor Drains WATER SYSTEM '
Hoppers Size
Restaurant Sinks � , �� Material
Sand Traps TOTAL FEES
Urinals Fixture Fee -
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fe
Permit Fee �.
TOTAL TOTAL FEE-
RECORD OF INSPECTION
Partial Rough
Rough Complete, _
, Final iD /a —