51022 2LOT NO.
NO. 0`1 'ITR-5ST
11 �.
N APPLyCATION FOR PLUMBING PERMIT
z -` �GITY OP CUPERTINO
Ep VOCT271966 �%
x o Sanitary No.
3 a Date 1962 Permit No S%DoZ.eZ_
CIT OF PERTINO Fee $
LLw 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
i a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and allotherlaws applicable thereto.
o_ o Use of Premises r
3 Owner .'/ Address // .2 (L
o By - o Address —=Z�
w z
a o State License '1�3/S�a�l3 Approved
-0 PLUMBING INSPECTOR /
UNITS FEES UNITS FEES
Water Heart Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 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 O o
Area Drains Main Drain Fee
V-ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee p v
Permit Fee p p
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...