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LOT NO,
NO. STREF.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
x o Sanitary No.
I DareI Permit No
3 U 'J U L 3 3_ /U Fee S �Sb
1 LL
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes I -p fix6�yWs 1 se side hereof, and agrees to install said rices
i I and/or ikth ski 5cc�c4l-Sth� t irovisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises
00 �
3 '"Owner &I L, Address 5-A r/ 47-
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z By�+ Cc Pt>�� Address-376 PtCLRvf76VT 'S�T
0 CONTRAC7(r4ENT
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— 0 Phone 2�I 7 — �y 67 ^
as 90� 7'3C- �0 V
o Stale License 2 .3 Approved
PLUMBING INSPECTOR ✓J
I
FIXTURES J BLR MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate /.Jb 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 PWATER
AINAGE
Washing Machines
Water Softeners
Bar Sinks
Com . Sink s Trays
Dental Units
Drinking Fountains
Floor Drains M
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /.So
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 2_�
TOTAL TOTAL FEE 3 �0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final