51087 (2) Zl�� yL A.�HA4. Auk J�L LOT NO.
NO. I[SIRf ET Q
APPLICATION FOR PLUMBING PERMIT
� ' ® u,HITY OF CUPERTINO
r o IJAN 19 ;1/%! �IJJ Sanitary No.
4 a b b 196— Permit No 5 0 J
3 LL �� F CUPERTINO Fee $_ /7/"' .
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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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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0 LL Use of Premises
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O < Owner Address 2YX-
0 Q� A41 /
zBy ��- / Address
— O CONTRACTOR AGENT
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- 0 Phone1
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o State Livens Approved
—U ;�- P UMBING INSPECTOR
FIXTURES 1 BER MAIN
UNITS FEES UNITS FEES
`.Yater 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 a Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee'
re DDrains Main Drain Fee
ZYater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final_.