2665 In' ^/ COT NO.
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�1�IAR' TI � FOR PLUMBING PERMIT
d 'II1 OF CUPERTINO
x o Sanitary No.
3 a DatCITYrAf,SUPERTiNP19'6`/ Permit No.
w Pee O 10
2 LL
0 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
'za and/or fixtures n'accordance with the provisions of the Plumbing Code of the City of
a w Cupertino/and all:other laws applicable thereto.
LL Use of Premises
00 �� / y
3 Owner//'//-��/ Q/ -�—t� Address/�//p//D�///�ii1✓ n
z By���.�iU,,�.(/i ��/Yi/�-/0/� Address ,-
O CONTRACTOR.AGENT
3 � �7� �
W Phone, �
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ao State License_ %S �C1 -Approved
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I. , PLUMBING INSPECTOR
FIX I URES NUMBERMAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Jr/� Size !� "
Water Closets �, Mawria,�/�
Bath Tubs To Curb
Showers ) To Prop. Liner'
Lavatories ^�� To Existing
Kitchen Sinks Not Conn.
Dish Washers /y Sewer Boxes
Waste Disposals (j
Wash Trays STORM DRAINAGE
WY Shing Machines I U Size
\lister Softeners Material
Bar Sinks To Main Drain
Comb. Sink c Trays To Curb
Den Units - .
Drinking Fountains
Floor Drains WATER SYSTEM
Hop' Prs Size / PA
Restaurant Sinks Material /f',
San Traps TOTAL FEES
Urinals Fixture Fee ) rU�
Area Drains Main Drain Fee , )�
'sVater Leaders Storm Drain Fee
Sprinkler Vaivcs Water Sys. Fee hl(V
Permit Fee
TOTAL )� (��� TOTAL FEE
RECORD OF INSPEC N
Underground Rough...
.Partial Rough..
Rough. Complete..
\-Iain Drain