1802' /oasl I �.Y• ` LOT NO.
NO. STREET
DPI AMN FOR PLUMBING PERMIT
`gyp TY OF CUPERTINO
Date SE 6k 190' Permit No—
CITY
CITY OF CUPERTINO Fees
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
a� Cupertino, and all other laws applicable thereto.
La' Use of Premises_
a ���„�
o Owner � to "'-, Address
XA Address
% PhOO1040 Longfellow Avenue Approve
Campbell, California LLHKiWG INSPECTOR
-1'iX'I fJRNUMBER MAIN DRAIN
UNITS I FEES I JUNITS1 FEES
(Water Heater Size
Water Closetsterial
'Bath Tubs �� Ta Curb
Showers �� To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers SEWER BOXES
Waste Disposals ��—
Asr �� STORM DRAINAGE
Washirtg Machines �� size
Water Softener Material j
Bat Sinks ToMain Drain
Comb. Sink rays 11 To Curb
Dental Units I P
Drinkii.g Fountains IR
Floor Drains �� WATER SYSTEM
Hoppers SI2C
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals_ Fixture Fee
Arca Drains 11 Main Drain Fee
Water Leaders _� Storm Drain Fee
Sprinkler Vaiveii II Water Sys. Fee
Permit Fee
OTAL �� OTAL FEE
RECORD OF INSPECTION
Partia Rough
Rough Complete
Final