NO PERMIT NUMBER LOT NO.
NO. STREET '
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
D
Date —'^� 19 P At,
No.
d`
v T 1968 W � Fee$
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listedf on ate r�versC;iHB2 l ri ll agrees to install said prices
f"! and/or fixtures in accordance with the provisions of thd`Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner II`) J� �, I� Address LO
By r INh Address f g�S Or✓+
CONTRACTOR, AGENT Q
[I Phone _ Approved
^'" PLUMBING INSPECTOR
SURES NUMBER MAIN DRAIN
I UNITS I FEES 11 IUNITSI FEES
Water Heater I Size g- y �.d
Water Closets Material I
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Coon.
Dish Washers II
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines I Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb 1 I
Dental Units II
Drinking Fountains II
Floor DrainsI 1 11 WATER SYSTEM
Hoppers Size 2" � �lL
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals_j Fixture Fee
Area Drains Main Drain Fee
Water Leaders _� Storm Drain Fee
Sprinkler Vzwes Water Sys. Fee i
Permit Fee IC,3
TOTAL TOTAL FEE _5-0
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final