1935 (2) llf_�J�� I' �V'Iy Y 6 (_L-• V it '.OT NO.
NO. STREP.t'�
ii
APPLIICATION FOR PLUMBING PERMIT
i < i`'� y,,, .CITY OF CUPERTINO
w Z W
E o SanitaryNo.
3 a Dat '/1 196•; Permit No
W , r,,JAN 21 1363 1�" Fee $
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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
r r- and//o tftxturesNn aeCdr-dance'withfthe provisions of the Plumbing Code of the City of
a w Cup`ertih01, andrall lother fl w�5"Heable thereto.
W I
a ~ Use of Premises
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0 0
o a Owner Address l O-DD r I o h ULlf R
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o By— 2, nt L.4F Va I. % Address 101LAW
rs ?- Y3honewtate License 1CJApproved2NSp , o
FIXTURES M E MAIN DRAIN
UNITS
—
UNITS FEES UNITS1 FEES
Water Heater 11 Size
Wate; Closcts 'Materia'
Bath.Tubs To Curb
Showers To Prop. Line
LavatoriesTo Existing
Kitchen Sinks Not—co,,.
Dish �YWashers Sewer Boxes
Waste Disposals
Wadi Trays= } STORM DRAINAGE
Washing Mac-Mnes - _ Size
-.dater Softeners Material
Bar Sinks To Main Drain
Cumb. .Sink c Trays To Curb
Dc•iitel Units
Drinking Fountains l
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Druins Main Drain Fee
Water Leaders Storm Drain Fee
SprinklrrValves Water Sys. Pee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough.. -
Rough� m
. Coplete..
Main Drain
Final...