1905 LOT NO. Via
NO. S
j APPL a!I N. FOR PLUMBING PERMIT 3
All 7 ��53 Lam.'- OF CUPERTINO
v
Date Z— 33 19TH Permit No.
CITY G:'. V L NIV
� Fee a ✓9
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 Oth laws applicable thereto.
8 Use of Premises
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K1"UMBWG
AddresAddresAPprov
I URES NUUMBER M R I
I UNITS I FEES UNITS FEES
Water Heater I / I I Size I
Water Closets i 2Material
Bath_Tubsj 7
I To Curb
Shower I / I Ta Prop. Line I I
Lavatories I $ I To Exis ' g
Kitchen Sinks I I No on
Dish Washers I / I I SEWER BOXES OR�17
Waste Disposals
Wash Trays I STORM DRAINAGE
Washing Machines I I Sue
Water Softeners Material I I
Bar Sinks I To Main Drain
Comb. Sink &Trays) I I To Curb
Dental Units I I II I
Drinking Fountains) I 11 I
Floor Drains II WATER SYSTEM
Hoppers I I Fize 1.
Restaurant Sinks I I I Material
Sand Traps I I II TOTAL FEES
Urinals I I I� Fixture Fee ,,, I ,.•._
Area Drains ( I Main Drain Fee I ; ..�-
Water Leaders I I Storm Drain Fee-
at . S s Fee —o
Sprinkler Vawes I Y � ��-. 'iF•`�
II Permit Fee
TOTAL TOTAL FEE / 04;
RECORD 9E.,INTION
Partial Rough
Rough Complete�j
Final
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