2342 p�V3/ � LOT NO. •Y V
APP LICiON FOR PLUMBING PERMIT
W z ?( AUG 13 1963S �F:ITY OF CUPERTINO
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3 u alr tnr 711 m 196— Permit No
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� 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 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of Premises
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CONTRACTOR,AGENT
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�/ PLUMBING INSPECTOR
FIXTURES D ER MAIN DR I
UNITS I FEES UNITSI FEES
Water Heater Size
Water Close's Material CS
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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Ilotir Drains RATIR SYSTEM
Hoppers Restaurant Sinks al Co
San Traps TOTAL FEES
Urinals Fee
Area Drains Drain Fee
Water Leaders Drain Fee
Sys. Fee
Fee �bD
TOTAL TOTAL FEE / [c •oo
RECORD OF INSPECTION
Underground Rough._ vz�:/-
I..Partial Rough.. 1-
Rough. Complete..
'Iain Drain -
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