51125 (2) s
OT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z `
wz CITY OF CUPERTINO
r o Sanitary No.
0 a Date 196 Permit No
3
i n - Fee 313
' 0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws a phcable thereto.
' w S
_ f r
Use of Premises
_oo
1 N
3 Owner Address
o,
-o By / - ---y Address
- F CONTRACTOR,11GENT -
—_N - Phone� 3 9'
- w z
E- a_o State License ," Approved of OF
—0 . o
PLUMBING INS EGTOA
I
- _ I
IXr=7 - m
UNITS FEES ` UNITS P.1!
ater Ideate Size -
`W-iter Cosmo Material"
Hath Tins To Cuili'
Showers I To -Prop. Line
Lavatories To Existing -
`Kitchen Sinks Not Conn.
is th Washers Sewer Boxes
,Waste Disposals
'Wish Trays / STORM DRAINAGE
:Washing,Machines Size
\Vater Softeners Material
Har Sinks To Main Drain
�oSine s `frays To Curb
,Dentar Units _
rinkinng Fountains
77r :Drains WATER,SYSTEM _
.Foppe� rs— Size
'Restaurant Sinks Material
S.pcl Traps TOTAL FEES
,,U,rl ia�— Fixture- Fee' Ai V-0
rea rains Main Drain Fee
�Water Leaders Storm Drain.Fee.
.- prinklcr Valves Water Sys. Fee
Permit Fee
TOTAL p w TOTAL FEE
RECORD OF INSPECTION
Underground Rough _
` .Partial Rough
IRough. Complet�
'.M.ain Drain -
i "Final .