51087 O ✓ �' _`�'�. LOT NO.
NO. Q 5
DI ITI FOR PLUMBING PERMIT
a OP CUPIiRTINO
W2 LLo MAR 3 t�s6 Sanitary iso.
Y
0 a Date / — 196 Permit No
LL CITY OF CUPERTINO 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
i and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other applic le hereto.
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., Use of Pre ises
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0 3 Owner -�-C� ress
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O CONTRACTOR4— GENT
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— am Phone 7
z 41 ,30
u f State Licei / Approved
a o
U� PLUMBING INSPECTOR
FIX I URESNUMBER
UNITS FEES UNITS FEES
Water Heate Size
Watc9 Closets Material
Bat Tubs To Curb
S ewers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners , t: . Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size 71
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Pee
Water Leaders Storm Drain Fee .
7-I.rinkler Valves Water Sys. Fee ,
Permit Fee Q
TOTAL ACORD
Q TOTAL FEE L,4, Q D
FINSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final