NO PERMIT NUMBER '' OS90 1 He reed<--s f99;
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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r o Sanitary No.
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_ rvn 196 Permit No
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' Fee $ 3
° En 31 made in 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
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and�aJ oche` 13w'�applicable thereto.
a Use of Premises
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3 Owner • Address - 4C—e !
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CO CTOR,AGENT
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u f State License /�9U Approve
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U PLUMBING INSPECTOR
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavaturies To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wasli Trays STORM DRAINAGE
)Washing Machines Size
Water Softeners' Material
Bar Sinks To Main Drain
Com . Sink u Trays To Curb
Dental Units
Drinking Fountains
Moor 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 Valves Water Sys. Fee
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...