51037 ///f / �� ✓ �" • LOT NO,
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z d CITY OF CUPERTINO
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x o � Sanitary No.
3 < Date 196f Permit No �
r 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
a < 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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w Use of Premises
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3 Owner((�I�(L�ltz� yyC��• ' N Address. ��p��/ ��t l�fw� Kylft
zz By ( ". j/�/c.d /�! Address �Do2s��dr9
CONTRACTCk,AGENT
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W f State LicenseApprove
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—U PLUMBING INSPECEOR
FIX I URES NULN, BER MAIN DRAIN
UNITS FEES UNITS FEES
'Vater Heate size.,
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sins 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 s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee o2 i
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee o
TOTAL TOTAL FEE °O
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...