1400 3L I` •• � �r=-K, LOT NO.
MOIEBPPP�LIC�Ay_TION ppF ''R PLUMBING PERMIT.
8, 19 '�l ®E CUPERTINO
O Date /ITl y II}P Permit No. C)
Fee $
Application is hereby made to the City of Cupertino for a peimit to install plumbing
Pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
0 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of.
Cupertino, and all other laws applicable thereto. `
Use of Premises P Atti "—.t
:a .��.
�1.—�
41
.. Ownel � '/ VOA tv�_ Address !1 a�l ien. n l
! o •
Address w.
�� NTRACTO A EN
(/ Pho ey Approved
�, PLUMBING INSPECTOR I
FIXTURES NUMBER MAIN DRAINrr;p
UNITS I 'FEES I UNITS FEES
Water Heater Size f
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line '^<�
Lavatories To Existing
[Kitchen Sinks Not.Conn.
Dish Washers �' �� '�•
Waste Disposals .�
\`Uash Trays - ��. STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays, To Curb
Dental Units
.`Drinking Fountains) �i �-�.
Floor Drains WATER SYSTEM '
Hoppers Size 47 1
Restaurant Sinks Material c [j
Sand Traps TOTAL FEES.
-
Urinals Fixture-Fee ' .
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee
Ql Permit Fee '4
TOTAL --H- OTAL FEE
RECORD OF INSPECTION
Partial Rough ..°`.�
Rough Complete