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/ LOT NO.
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?V, `AP-PL'ICA�TION�FOR PLUMBING PERMIT
Nrl,i .[TY, OP CUPkiRTINO
s `o A 12 sanitary No.
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0 a Date 196_ Permit No.3 LL CITY 0 CUPERTINO Pee $
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� Application is hereby made to the Cit}' 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other lawsa licable thereto.
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LL Use of Premises
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3 Owner _ & �' � Address AP ;rZ • e4 4/
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W i Phone— /y
ao State License ° /JD Approved t�`'�� "'u•` /h l
–U (kt PLUMBING INSPECTOR
FIXTURES M
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sulks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
VVILS Trays STORM DRAINAGE
Washing Machines Size
Water Softeners , Material
Har Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee /
TOTAL TOTALFEE p0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final