51088.1 (2) 1010 C a ' 4v A ` LOT NO.O�
NO. STREET
APP�L'ICATION FOR PLUMBING PERMIT(�� T J I J
f �,) CITY OF CUPERTINO
� I� ,
LOa(D E 7 190— Permit No. 0 Of 1
n•--�/ n" 1 �.0 Fee $� J
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and 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
g Cupertino, and all other laws applicable thereto.
d --
I; Use of Premises
Owner " Address I I
By _ Address 40
CONTRACTOR, AGENT
Phone 13 Approved
„J ✓ PLUMBING INSPECTO
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water H,.ater I Size
Water Closets Material
Bath Tubs To Curb
Showees To Prop. Line
Lavatories To Existing
Kitchen Sinksj Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains II
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks I Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders ._ �� Storm Drain Fee
Sprinkler Varves Water Sys. Fee
Permit Fee '2-00
TOTAL TOTAL FEE QO
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final