NO PERMIT NUMBER NO Imo® S EF.rj LOT NO.��
APPCA O FOR PLUMBING PERMIT
�MqY _ I;/ OF CUPERTINO
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° Application is hereby made to Pe 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 rices
and/or fixtures in accordance with the provisions of�'�the..!.P�.I�}�mjbii g Code n tl e Gty of
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Cupertino, and all other laws applicable thereto. / �-�+�✓ —i�`.P��- 1,-3
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Use of Premises a
3 Owner I Address� (i/r-S u( ./�a-- 7414 .
Z By 7/�.. . 5C/C tCLi�*d �.. Address
3 0 CONT (.TO[t, AGENT
— Phone 73/0' �y ✓
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aoState License Approved
04PLUMBING INSPECTOR /
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141XTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
UTubs,,;
Heart Size 5/
sets Material 0�.j
Water
To Cur
To6Prop. Line
To Existing Not Conn.
siWashers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Was int Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drin ing Fountains
F oor Drains WATER SYSTEM
Hoppers ize
Restaurant Sinks Materiat 6,q
an raps TOTAL FEES
Urinals Fixture Fee t
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Slain Drain
Final