828 (2) LOT NO.
NO. STREET Z _
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ION FOR PLUMBING PERMIT
1 CITY OF CUPERTINO
JUO Date/� 191-6.0Permit No. y
CITY OF. CUPEKDNO Fee $ 4So
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 allothher laws applicable thereto.
Use of Premises %. a2�
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Address .4 d �oZd 7. -
By Address
CO CTOR, AGENT .tl�
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PhonQApprove
PLUMBING INSPECTOR
—FI--XTURES NUMBER MAIN DRAIN
UNITSFEES UNITSFEES
Water HeaterI I! Slze
Water Closets terial
Bath Tubs I jj J1 To Curb
Showers , 11 To Prop. Line
Lavatories '1..7ToTo Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays IISTSTORM DRAINAGE
Washing Machines �� 11 Size
Water Softeners 11 Material
Bar Sinks 11 To Main Drain k'r
Comb. Sink &Traysl 1 11 To Curb •�;'
Dental Units
Drinking Fountains I ' I�
Floor Drains 1 1, 11 WATER SYSTEM
Hoppers 1 1 ' 11 Size
Restaurant Sinks 1' 11 Material
Sand Traps 1 11 TOTAL FEES
Urinals 1; Fixture Fee
Area Drains Main Drain Fee .%
Water Leaders Storm Drain Fee
Sprinkler Valves ' Ij Water Sys. Fee
11 Permit Fee
TOTAL 11 TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Ro gh Complete _