51134 Ea 12
P [ lcF— �/I/J — LOT NO,
NO. STAEEI'
PLICATION 'FOR PLUMBING PERMIT
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`?� (ITY�OF CUPERTINOyo t2 1967S:mitary- No.
Q 0o < DateP96� Permit No —5 IIJ 24
3
o PITY. ni PI a�3C]'/`T11 Fee 5 3.
Ap�llicationjis hereby madc�to]tlie Cit}• oC 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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JI _Use of Premises w
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' "3 OwnerF SEN FoGO Address /98'66 ppgp- &tF-6- 1..,.
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O CONTRACTOR, AGENT
— am Phone
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a o State License ; O Approved
PLUMBING INSPECTOR/
it µ
l;lX,l URESJ
UNITS FEES UNITS FEES
Water Heate Size
Water Clase,s Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
bar Sinks To Main Drain
Com . 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 �.r0
Area rains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vatvcs Water Sys. Fee 00
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
. Iain Drain
Final