1413 (2) LOT NO.
Qt4UEET
® A ATION FOR PLUMBING PERMIT
T,r FE6 13 i96 CITY OF CUPERTINO
C�TY I�a�e 19 �Y ,_Permit No: J f
v�". .. `Fee $
Application is herebimade;to-the City of CupertinoIfot a permit to install plumbing
t,,Tipes 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
r Cupertino and all other laws applicable thereto
-Use of-Premises
� Ow ' di"SS �3
9y IA NA ERf/
ss
E C R ENT '
I Phone S S l76 Approved
PL MBING INSPECTOR �'.
FIXTURES NUMBER MAIN DkAINtjt',-
I UNITS I FEES- II IUNITSI FEES
Water Heatcr Sae Pa'
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line -
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size j
Water Softeners Material j-
Bar Sinks To Main Drain f
Comb. Sink a Trays l ll To Curb
Dental Units 1. 11 11 l
Drinking Fountains) ll
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee '„ 'ili
Area Drains Main Drain Feel '^
Water Leiders Storm Drain Feel
Sprinkler Vaivcs Water Sys. Fee I P.
sEwER BOXES Permit Fee
TOTAL , TOTAL FEE .
RECORD OF INSPECTION
Partial Rough
Rough Compl to
Final G L ..
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