1907 2 / G / of—� i7Y LOT NO. i!!Q
NO. STREET
3
�RPUCW4TION FOR PLUMBING PERMIT
P✓ �'] C Cot_ of CUPERTIIVo •
Date "`3iR: :1 Permit No.
CITY C . �1!°tRTII�Q Fee $ i9
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 other laws applicable thereto.
Qj
Use of Premisrs �'�
V Owner/r•�i�•+^•,+,'yQji�r"k.^� Addres
By L�ta:,n� .ih !/ Addres C :<3✓ :•,
CONTRACTOR, AGENT ✓ t,z'Zy'�
Phone -r;Y 2 21<!'d 2 Approv '
PLUMBING INSP OR
1
URE UM IiR MAIN DRAIN
UNITS I FEES 11 JUNITS1 FEES
Water Heater I Size �—
Water Closets C4 Material
Bath Tubs I To Curb
Showers / To Prop. Line
Lavatories $ i jj To Existin f '
Kitchen Sinks No Conn.
Dish Washers
Waste Disposals
Wash Trays ( STORM DRAINAGE
Washing Machines Size
Watei Softeners JI Material ( j
Bar Sinks To Main Drain
Comb. Sink & Traysj To Curb
Dental Units
Drinking Fountains it _
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Trapsl TOTAL FEES
Urinals Fixture Fee ct'
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee,
Sprinkler Valvu I II Water Sys. Fee
Permit Fee ,-� -
TOTAL TOTAL FEE v%
RECORD O CTION
Partial Rough
Rough Com to o —
Final � `