645 U
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V ."c"1,. LOT NO.
STREET
PPLlCATION FOR PLUMBING PERMIT
r OF CUPERTINO _
D 196-!2 Permit No.
O
Fee $
%n 4 il� �t
1 cat -is ertby�r T til ge 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.
d �
Use of Premises
a a
y�^' b
0
Owner V — Address D
By. .S Address r c. '�'
CON CTO ENT
'�' Approve
Phone ., — PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water Heater j Size
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 .��I Size
Water Softeners , Material I
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains II
Floor Drains �WATER SYSTEM
Hoppers I I( Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals jj Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vatves ( �( Water Sys. Fee
-_ � Permit Fee
TOTAL f TOTAL FEE
RECORD OF INSPECTION
i Partial Rough
Rough Complet
Final ►�