51038 ",2V 7 ( <QJ D,q LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z a CITY OF CUPERTINO
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Y ° Sanitary Nu.
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0 < Date - It
_ Permit No .S"i 0 30
U doPee5° Appl at,q q to e�yq to ityof Cupertino for a permit to install plumbing
o apipes an /of�fi3rtu `lisii'dn therse side hereof, and agrees to install said prices
i m` and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cuper nle thereto.
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LL Use of Premises
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3 Owner K tdAddress
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o By* Y �/ Address
3 0 CONTRACTOR,AGENT
— u`. Phone
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ao State License Approved
U PLUMBING INSPECTOR
FI.
UNITS FEES UNITS1 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 Disposals
Wash Trays 11 STORM DRAINAGE
Washing Machines Size
Water Softeners Material
tsar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee j &^Jt
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Tprinkler Valves WLOU Water Sys. Fee
Permit Fee
TAL TOTAL FEE 7
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final