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LOT NO.
NO. STREET
LV`APPLICATION FOR PLUMBING PERMIT
I 6 1963 CITY OF CUPERTINO
MAY 1
Sanitary No.
Date C3 T A 196 Permit No 0 O
Fee $
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 all other laws applicable thereto.
Use of Premises
Licenses f L !7
c
Address O O
Address
Approv -�
PLUMBING INSPECTOR
I UNITS I FEES II 1UNITS I FEES
Water Heater
Water Close
Bath 1 ubs
7 o Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
WATER SYSTEM
Wash Trays
STORM DRAINAGE
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink s Trays
To Curb
Dental Units
! 0 Water Sys. Fee
Drinking Fountains
Permit Fee
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
I Material
Urinals
Fixture Fee
Area Drains
-Water
Main Drain Fee
Leaders
Storm Drain Fee
Sprinkler Vcuves
! 0 Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough Complete..
Hain Drain
Final...