51137 LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
"
wz a CITY OF CUPERTINO
x o Sanitary No.
7 7
o f Date V J 196 Permit No J—// d"
a
Fee $
� 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 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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Use of Premises00
5of/� L -� �I - Address
o
< Owner
o Address a/«
By D�dA/� J./� �!/ /
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- 0 PhoneSQL 4 O 2
W
aoState License ", -Approved
_O CONTRACTOR, AGENT
FIXTURES UTN F I
UNITS FRES UNITS FLES
Warer Heater Size
Water Closets Materia!
Hath 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
'�Xlater Softeners Material
Bar S4&�nk &
To Main Drain
ComTo Curb
DentDrinflooWATER SYSTEM
HopSize
RestaMaterial
San�Traps TOTAL FEES
Urinals Fixture Fee /Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee C
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete..
\'Iain Drain
Final...