940 (2) LOT NO.
- NO. STREET
APPLICATION FOR PLUMBING PERMIT
'?CITY OF CUPERTINO
D ^ 190 Permit No. 19
T 181%0 Fees
Aliis hereby made to the City of Cupertino fora permit to install plumbing
pipes anr fi>�£i a reverse side hereof, and agrees to install said prices
and/or fixtures �n accor th the provisions/ sons of the Plumbing g Code of the City of
Cupertino, and all other laws applicable thereto.
O
b' Use of Premises
we Owner Addres t'✓tCl.�u
C V °
By_ P�^ e Ad
L [�/ CONTRA&6R/wGEN7
i_�,a Phone`+ e APPf° pLnNEING INS OR
URF.S NOSIBER M IN R
-i I UNITS I FEE'S JUNITSFEES
Water hie t r I I II Size
ate, C osetS Material
-Nath TubsTo Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks i Not Conn.
Dish Washers SEWER BOXEl
Waste Disposals
Wash Trays STORM DR'AINAGE'.
Washirg M:Ithines p Size
Wute�r�Sd ners �' Material
Bar Sinks;-•a - To Main Drain
Comb:°Sink &Trays) To Curb
Dental U its s
(, Drinking Fountains)
Floor Drains WATER SYSTEM"
Hoppers
Size-, _
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains II Main Drain Fee
Water LeadersStorm Drain Fee
Sprinkler Naives I Water Sys. Fee I _
Permit Fee
tTOTAL 1 TOTAL FEE
RECORD OF INSPE TION
-Partial Rough
Rough Complete
Final d /.