51046 /v_7o `7z
OT NO.
NO. STq
APPLICATION FOR PLUMBING PERMIT
< CITY OF CUPERTINO
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o < Dat 96— Permit No
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19
U 1967 Pee S
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r o App i anon is hereby made to the City- of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed oTn th ({ceerse side hereof, and agrees to install said rices
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and u n c R fs4lY,e provisions of the Plumbing Code of the City of
a w CuptSAn! wall It re'r Ties applicable thereto.
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Use of Premises
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oa Owner �t1 o C� Address
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By P'
7__.7___'yl-"r--� Address 0 ' X
3 CONT ACTOR, AGGNT �o.�
Phone
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ao State License :;23 7 y Approved w /
U PLUMBING INSPECTO r/
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F1, 1iIN
UNITS FEES UNITS FEES
`JVa[cr Heate Size
\X�ater Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\�as"h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bat Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hop rs y„d o, Size
Rcs aurant Sinks Material
Sand Trap 143� 1 TOTAL FEES
Urinals �-c.
/,-)71 Fixture Fee yz
Area Drains Main Drain Fee
hater Leaders Storm Drain Fee
5prin 'ler Valves Water Sys. Fee
Permit Fee y_
TO AL so, TOTAL FEE /, p
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final