295 (2) LOT NO.�
NO. ATREET ai, •` ��
APPLICATIO FOR' PLUMBING PERM (�
CITY OF CUPERTINO
Date ''' 195_ Permit No.
40
t:. Vj Fee $
i
11 itj ( de City of Cupertino for a permit to install plumbing
pipes orrfisIf o 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
Cr�2l�ilfo, a W RT1 czbleyth�eto.
u Use of Premises
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Address- �x5 1 — ���.
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By Address
CONTRACTOR, AGENT'.
Phon e�l/ _ Approvedl�/
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hearer Size
Water Closets Material
Bath Tubs l ll To Curb
Showers To Prop. Line'
Lavatories To Existi❑
Kitchen Sinks
Dish Washers �
Waste Disposals IIG
Wash Trays STOR AI AGE
Washing Machines l Size
Water Softeners Material - I
Bar Sit ics To Main Drain
Comb.,Sink•a Traysl l li jo Curb
Dental Units
Drinking Fountains) l -
-Floor Drains I WATER SYSTEM
Size
.,•' -�
Hoppers �" ;;;:
Restaurant Sinks Material iI? ,: l
Sand Traps * TOTAL'FEES
Urinals _sI 'Fixture Fee "
Area Drains Main Draih Fee �, QQ'
Water Leaders l JC-Storm Drain Fee l
_Sprinkler Vaives I II•`'Water Sys. Fee
Permit Fee Jfu,
TOTAL TOTAL FEE yP41 YJQ
REC RD OFTSPFCTIONi.
'I Partial RouAk� i,5 Rough Complete
Complete
Final /�_ t/ 3 f -_?�, 4,"ri•.'