51003 /G �--J I '1__ Y'Lf_: �/' I LOT NO.
NO. SntET - - -
APPLICATION FOR PLUMBING PERMIT
z CITY OF CUPERTINO
r o OrT OF cu� p Sanitary No., '
0 Date W,D , I9 I- Permit No '5-i < C'.3
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Pee$ �SZ
Applicgiory�is r • made to the City of Cupertino for a permit to install plumbing
-s 'o Y pipes ani/or!iTutJkes sled on the reverse side hereof, and agrees to install said priccs
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
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,. Use of Premises � 1 d 2 N-Jt--e-
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5 3 Owner , C4ddress 105-3:1 exr x_va_
01
z Bym+ Address
° C NTRACTOR, AGENT
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w i bPhone._ q / b
R a 2lel' .S �~:
u E State License a7' Approved
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- 0 PLUMBING INSPECCOR
FIX-1 URES NUMBER MAIN DRAIN
-UNITS-1 FEES $iZeUNITS FEES 1.
'`7Vater`Heate — •
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks :'Not Conn.
'Dish Washers Sewer Boxes
,Waste Disposals -
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material t
Bar Sinks _ To Main Drain
Comb,Sink & Trays •-To -Curb
Dental Units
Drinking:Fountains -
Floor Drains WATER.SYSTEM
-Hoppers - Size
Restaurant Sinks Material
San 'Traps TOTAL FEES
Urinals Fixture Fee
•Area Drains Main-Drain Fee
qr ater Leaders Storm Drain Fee
j Spin Fier Valves Water Sys. Fee
Permit Fee
`TOTAL _ TOTAL FEE
RECORD OF INSPECTION '
Underground Rough.;.
Partial Rough..
Rough_
Rough Complete..
�Qain Drain
'Final ��
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