5110711 ® LOT NO. /w
n0. 41"T
APR 2 g � �pION FOR PLUMBING PERMIT
wz
CITY OF CUPERTINO
CITY OFA ���� � Sanitary N0.
0 j Date 196_ Permit No J-/'/c'/'/c' 7i
= o
� Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
w x
.. Use of Premises r-
0 0
o a Owner` 7 + L�� \. Addressa�Or)A rfiC to• t-..�,�h�4Q •
J Z syADVANCE PLLT11 ING CO'. Address 02 4 —
3 - CONTRACTOR, AGENT
— Wa Phone
aoYState License /MA 9� Approved
—U J517 PLUMBING INSPECTOR V
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks 113 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
WaA Trays STORM DRAINAGE
Washing Machines Size
_Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTE
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee --
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
�prinl:ler Valves Water Sys. Fee pp
Permit Fee
TOTAL TOTAL FEE , 0(
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
Main Drain
Final._