1478 // 3.� I Q V V� '`� LOT NO. ✓ �
NO. N R PLUMBING PERMIT .
FfAR 3 0196il CUPERTINO
Date . Permit No.
�. PERTINO pee $ y
Application is hereby made to the 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 haws applicable thereto.
Use of Premises /
:a
4i Owner Address
By Address
CONTRACTOR, AGENT (/
1�7 -v Phona;7— 'y 1 Approve
PLUMBING
INSPE O
FIXTURES NUMBER MAIN DRAIN
UNITS FEES IUNITS FEES
Water Heater / I II Size
WaterClosets 3 Material
Bath Tubs / II To Curb
Showers j To Prop. Line
Lavatories To Existing
Kitchen Sinks N Co n'
Dish- Washers
Waste 'Disposals
Wash Trays II STORM DRAINAGE
Washing Machines / Size
Water Softeners Material I
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains)
Floor Drains WATER SYSTEM
HoppersSize / I
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee J,
Water Leaders Storm Drain Fee
Sprinkler Varves II Water Sys. Fee , 0.,e)
Permit Fee 6--)
TOTAL TOTAL FEE
RECORD IN4PECTION
Partial Rough
Rough Complete
Final