100039 LOT NO.
NO. STREET
APPLICA ION FOR PLUMBING PERMIT
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z Z CITY OF CUPERTINO
r oSanitary No.
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0 < Date �� 196 Permit No
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w LL 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 P robing Code of the City of
Q w Cupertino, and all other laws .applicable ther
Use of Premises �-
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3 Owner Address
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� z By�c[,�i O�i�9 �E Address �' •36 -Sn ./!-
O ONTRACTOR,AGENT
w 0 Phone --23 —S/ 5e
s State License--2 l 3Approved
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U PLUMBING INSPECTOR
141XTURES 1
UNITS FEES UNITS FEES
Water Heate Size F
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 s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee'
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler VolvcsWater Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete-
Alain Drain
Final...