51037 (3) aw . ✓ I / LOT NO.
STREETAPPLICATION FOR PLUMBING PERMIT
CITY Op CUPERTINO
Sanitary No.
196A aar No. f/ .� 7
Eee$
ion is hereby made to the City of Cupertino for a permit'to install plumbing
opipes 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 applicable thereto.
w x
r r
w Use of Premises HOUSEHOLD
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1- 3 Owner Wallace Carroll Address 11196 Linda Vista Dr.
°� Coast Water Softener Co apart no, a
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z By 8p7 �p Alamada Address
— m Phone
W z
w w770
ao State License O 3 Approved
U PLUMBING INSPECTOR
FIXTURES D BER MAIN DRAIN
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 10 Material
Bar Sinks To Main Drain
Com . Sink , Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee "'049
rea Drains Main Drain Fee
/ater Leaders Storm Drain Fee
Tr,,nkler Vales Water Sys. Fee ,o
Permit Fee �L,tN�
TOTAL TOTAL FEE 4 4Z,00
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...