2001 _ LOT NO. AOa
yf APPLICATION FOR PLUMBING PERMIT
/MAR 2 9 1963CITI!OF CUPERTINO
Date - -` --•�19�3 Permit No.
i r t,UrLI_: Q
Fee$ V
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
N%, 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 Premises62t[
.-a
a,
Owner Address�d•
Byp - _ Addr d
CO 7R.ACI'O AGENt /
Phone �5. -S�/1!y Approve
6-1 PLIJIMNG INSPECTOR
=I URS UM RX—IN —DRAIN
I UNITS I FEES II UNITS FEES
Water Heater Size
ater C o s sets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing ✓� ZO1
,Kitchen Sinks /,22 Not Conn.
Dish Washers 0XES
Waste Disposals
;Wash Frays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Ma
h rain
Comb. Sink a Trays To Curb
.Dental Fo R
Drinking.Fountains �I
�
C of Drains ( WATER SYSTEM
Hoppers Size
Restaurant Sinks-1 1 11_ Material
Sand Traps TOTAL FEES
Urinals Fixture Fee 371
Area Drains Main Drain Fee Z.i
Water Leaders Storm Drain Fee
Sprinkl~ Vatves I 1 11 Water Sys. Fee I
11 Permit Fee
'TOTAf L II TOTAL PEF,
REC RD INSPECTION
Partial Rough "
Rough Complete
Final
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