51088.1 �RAtZ LOT NO.
NO. STREET
f` APPLIC,ATION FOR PLUMBING PERMIT
V, r- , ' ' CITY OF CUPERTINO
loEC - 6 '19618
Date Z 19Q Permit No.
opma Fee S 02 . .S�
Application is hereby made to the City of Cupertino for a permit to install plumbing
t, pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
1 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
f Cupertino, and all other laws applicable thereto.
L Use of Premises
'a
h
Own ef ILLI iI,� QiA 1 "tom Address 5y60 df4a -e�i —
UNIT PLUMBING' Address o aN 4-tsµ
By ___ , ,
Palo A9 N'—GV `4,, NT Approved
Phone - PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITSFEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories , j To Existing
-K-kch n Sinks ,. SUI Not Conn.
Dish Washers 41 km I I
Waste Disposals Gas 04P +j1 3 1/,51)
Wash Trays STORM DRAINAGE ,
Washing Machines Size
Water Softeners Material
Bar Sinks. To Main Drain
Comb. Sink & Trays) To Curb
Dental Units
Drinking Fountains) III
Floor Drains I 1 WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals _ Fixture Fee .,,y
Area Drains II Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives I Water Sys. Fee
-1Qr Hkahbv 1 j 11 Permit Fee I vo
TOTAL 1 11 TOTAL FEE Z,14,
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final