51145 LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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' o Sanitary Nu.
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o a Date /�— 196Z Permit No 1�
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
'o < 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.
a ~ Useof Premises1
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oa OwneL�� i/e�✓ ems Address y n
z o B�.AzGv r%�—"—s�'sr Address
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O CONTRACTOR, AGIPQT
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a o State License—� �7.3cT0 Approved
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-U PLUMBING INSPECTOR
FIXTURES NUMBER
UNITS FEES UNITS FEES
Water Heate Si20 Zy rl
Water Closets / ,c 0 Material
Bath Tubs p To Curb
Showers To Prop. Line '
Lavatories ,—,,o To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wish 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 00 WATER.SYSTEM _
Hoppers Size
Restaurant Sinks Material .
San Traps TOTAL FEES
Urinals Fixture Fee 33.00 -
T,ea
3,00rea Drains Main Drain Fee �• 00
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 7
TOTAL TOTAL FEE 3�e9p
RECORD OF INSPECTION
Underground Rough...
Partial Rough-
Rough. Complete..
Main Drain
Final...