51039 /O//O I pha/ /ap or,• LOT NO.
NO. STREET
ION FOR PLUMBING PERMIT
OF CUPERTINO C�
Date'/_/ .g Ay Ica Permit No.
CITY n' Fee $
cV OF CUPEf I
Application is hereby UMP 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
110 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
�4 Cupertino, and all other laws applicable thereto.
d
P; Use of Premises
:4
Owner Address ' At'
'''^-�
By r � Address
CONTRACTOR, FNT
( Phone �!C' _ Approved 6()&I 1i—w
T� PLUMBING INSPECTOR
1
IX URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals II
Wash Trays STORM DRAINAGE
Washing Machines I Size
Water Sol tenets Material j
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountainsl I _ II
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains • Main Drain Fee
Water Leaders Storm Drain Fee
Sprin r give Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final