51134 /6„J 'a � /g& `"_.' LOT NO.
Nn. ST EEIf
APPLICATION FOR PLUMBING PERMIT
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® � IjT>,Y OF CUPIiRTINO i
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i1 S:mitary i\'u.
f3aUat •. ! t ;�I96— Permit No '.
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= w Pee $ .2
w w I plitatio�ypis here4y]tn� ?-� o the City of Cupertino for a permit to install plumbing
o a pipes'and%oiu•FixtuiAe'stl�sttd'b �hMeverse side hereof, and agrees to install said prices
> . and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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_ G/t Address .S6//VG ry'
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3 2 V CONTRACTOR, AGENT
- < Phone %S " 7G C{
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� a 95' 7y5
a o State License a Approved
U\\ PLUMBING INSPECTOR R
lily
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FIXTURES D E
UNITS EES I UNITS FEES
Water Hcate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink ,% Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL I TOTAL FEE rD
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .