NO PERMIT NUMBER LOT NO.
NO. STREET
l:
FOR PLUMBING PERMIT
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4701"1 CIYOF CUPERTINO
Sanitary No.
W° Date i 96�/ Permit No
3 �S d
W " r`r—li !1 r' ^l lnl'QTlnlr I Pee $ �4
° Application is_hereby made�to the1Cdty 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.
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a, LL Use of Premises
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3 Owner Address
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� o By Address
3 - CON'IRAC[OR, AGENT
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zPhone.
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W X38 �� .
a o State License Approver�.•�._' inrn D. I3e.NEVICH
U PLUMBING INSPECTOR
T
FIXTURES 1BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs / To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks / Not Conn.
Dish Washers Sewer Boxes
Waste Disposal
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
Floor Drains WATER SYSTEM
Hoppers Size n /
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee ,SO
rea Drains Main Drain Fee ,f, o
Water Leaders in Fee j ,Sa
Sprinkler ValvesWater Sys. Fee p
Permit Fee n
TOTAL TOTAL FEE O
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
Main Drain
Final....