51039 (2) LOT NO.�/
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z
wa CITY OF CUPERTINO
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r o Sanity y V'u.
O ' Date 196— ;me ' 7,0-?q
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Fee $ , 3p
O Application is hereby made to the City of Cupertino for a permit to install plumbing
'o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all otherla applicable thereto.
0 LL Use of Premises / �A :.�
00
o < Owner✓6 7'��� Address
z By <�:4[21F- A'4/y/7 SicAddress /d`Z-9.10VIP7ZF41 S. �.
J O CONTRACTOR, AGENT
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- 0 Phone 5-0.0 7 —
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ao State License > 72(;,,'1 Approved
-U PLUMBING INSPECTOR
FIXTURES NWN 13ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets 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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks - Material
Sand Traps TOTAL FEES
Urinals Fixture Fee 7, ()
Area Drains Main Drain Fee
Vater Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee 0-0
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough-- _
Rough. Complete.. '
Main Drain
Finzl---