51114 /off s3 L ^ 'F
COT NO.
NO. STREET
APPLICAT/ON FOR PLUMBING PERMIT
z '
z Z CITY OF CUPERTINO
WLL
YO Sanitary No.
W LL —///
0 < Date 2 196Y Permit No S
U
= LL Fee $
O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> . and/or fixtures in actor ce with the provisi0 -of the Plumbing Code of the City of
a W Cupertino, and all of er aws applicable-there '(
LL Use of Premises
00
> N
, 3 –Ownerf � K /I z'y ' /?fI 7—'f Addre /in r -4 3 C'a L l3 �V e- VH
ZJ
J a By i % 4 IJ ';A V Se e7 t✓IAE"Address 3y_ M,45W H%t/
CONTRA R, AGEEN/T� '%4PL6MB'ING
<0 Phone C°W W
a oState Licens Approv ((PE 'OR Z
FIXTURES NIJ,% BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
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
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 0>
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinller Valves - .Water Sys. Fee
Permit Fee `=
TOTAL TOTAL FEE -1
RECORD OF INSPECTION
Underground Rough._
Partial Rough..
Rough Complete..
Main Drain
Final...