51028 NO. STREET
APPLICATION FOR PLUMBING PERMIT
z CITY OF CUPERTINO
xIVo � - Sanitary No.
0 LL /
0 < Date 196_ Permit No
3 LL Fee $ '5z'Ll)
i o
Application is hereby made to the City of Cupertino for a permit to install plumbing
LL w said 0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
wx
a, LL Use of Premises
00 /
0 .J C i az I Gt Address
? z By U' 11 n ! r%�1... Address 1 �u/•% �(�
_ o
0
— Phony .y
W W State License 36 .-� "� Approved
¢ a
Q O
—0 CONTRACTOR, AGENT
FIXTURES M L MAIN DRAIN
UNITS FEES UNITS FEES
Water Hearer S12e
Water Closets Materia!
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
\Cater Softeners Material
Bar Sinks To Main Drain
Comb. Sink s 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
Water Leaders Storm Drain Fee
�prinklcr \a Ives Water Sys. Fee
Permit Fee /
TOTAL TOTAL FEE tlu
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
Main Drain
Final...