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Lor No. 7'/
o. 0 A D APJFOR PLUMBING PERMIT
I JU N 18 1985OF CUPERTINO
w
� 19D?J Permit No.
� Fee $ �
Application is hereby made to the City of Cupertino for a permit to install plumbing
�Q 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 laws applicable thereto.
Use of Premises
wne Cr . �. V V 6 S C7.
O
Address
—7 Address 3B
//C TRACTOR, AGENT
,r Phone ' V157- VS U _ Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES IUNITS FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays I �j STORM DRAINAGE
Washing Machines Size
Water Softeners Material I
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains II
Floor Drains WATER SYSTEM
Hoppers I Size
Restaurant Sinks �� Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains I Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I II Wafer Sys. Fee /3=
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final