51086 ga3 99 LOT NO,
NO. STREEI'
APPLICATION FOR PLUMBING PERMIT
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° -' Da196 Permit No `�� O VV
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P.Aplylicly�n ipl� ad to the City of Cupertino for a permit to install plumbing
o a fop lnd�„Ir fi tgr ialf1t �le 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
<w Cupertino, and all other laws applicable thereto.
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Use of Premises
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o < Owner.�liLA- &IL�t/ VL (0) L Address
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z By%.✓—�A rAF q4✓ c,r�/� ✓-�' Address 4. l d/acG.�tl,5/.W y;,
3 O CONTRACTOR, AGENT V
— Phone a-9 1?- ossl
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a o State License /71 S 37 ApprovedWILLIAM ❑_ rsan;.-...c _
U - PLUMBING INSPECTOR /
FIX I URESNUMBER
UNITS FEES UNITS FEES
Water Hcate 9 36011Size 11 Op
Water Closets 16 'I .6011Material ,
Bath Tubs A ,00 To Curb
Showers To Prop. Line
Lavatories (4. To Existing
Kitchen Sinks (o ty �y Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines ,0() Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size Z .
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee �Oa.pO
Area Drains ain Drain Fee
Water Leaders Perm Drain Fee ,7VV—
�prinklcr Valves Water Sys. Fee 115--o
Permit Fee p
TOTAL TOTAL FEE � .
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final