51037 7 14,,1, O N .
O. STREET
APPLICATION FOR PLUMIfING PERMIT
CITY OF CUPERTINO
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Y o Sanitary No. �'�/
o < Date _ 196 Permit No �+ , 7
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Wo W Fee $.
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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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws apphc thereto.
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0 LL Use of Premises
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Owner /� ddress y A
? z B L A&w 0-1 Address �7 7 ���. ��1 N9
J O y CONTRACTOR,AGENT
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— m Phone
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ao State License Approved
—0 PLUMBING INSPECTOR
FIXTURES ISIMN BER
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 Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee'
Area Drains Main Drain Fee
rU� ater Leaders Storm Drain Fee
5pdnkler-Valves
Water Sys. Fee
Permit Fee
TOTAL TOTALFEE #4
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RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...