NO PERMIT NUMBER LOT NO. ,
NO. STREET
® P 4C TION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Nov 9q r� �pc�+ /to y 8 i m/ry Permit No.
Cl1
OF 'COPERT Nnn Fee$
1� Application is hereby maAe to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
L Use of Premises
N Owner l/ ,rte Address 1013Y, eEo
gy ,CG .L vCC �cJ d Address —390
CONTRACTOR, AGENT
Phone Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater I Sae
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink m Trays 1 11 To Curb
Dental Units I 1 11
Drinking Fountains) II _
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final