51179iV / 'iL�•=• I �i u�f..0 �iC. • �" ( LOT NO.
NO. STREET
APPLICATION FOR. PLUMBING PERMIT
CITY OF CUPERTINO
Date .I e-eJ• 17 1Permit No. /l
UApplication is hereby made 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
h Owner��/�/ /7 /!�J LLc o Address/U/4/6
Address
'; CONTRACTOR, AGENT -
Phone7.�ly —a d 0-c> Approved
PLUMBING INSPECTOR
FIXTURES NUMBER
IvfAYN DRAIN
I UNITS I FEES
II
UNITS1 FEES
Water Heater
Sae
rDrains
Water Closets
Material
Hoppers
Bath Tubs
To Curb
Material
Showers
To Prop. Line
TOTAL FEES
Lavkories
To Existing
Fixture Fee I
Kitchen Sinks
Not Conn.
Dish Washers
Waste Disposals
Wash Trays
S RM DRAINAGE
Washing Machines � � ��,
Size
Water Softeners ��/
-lfateri'al'f' j
Bar Sinks j
o lyaiA Drain
Comb. Sink & Traysl/'J�
Curb I
Dental Units �� I II
Drinking Foun aisi I 1VA
rDrains
11
WATER SYSTEM
Hoppers
I Sizeel
ResNLrint Sinks
Material
Sand raps tt
TOTAL FEES
Urin is I-
Fixture Fee I
Area'Drain—s7/ l it II Main Drain Fee
Valves
RECORD OF INSPECTION