51064 LOT NO.
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pPLI1C p.TI FOR PLUMBING PERMIT
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a Imp OP CUPI RTINO
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� Application is hereby made to the 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 prices
> r 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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0 a Use of Premises
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3 Owner ��// A/�Ie� Address /eft 9�?� 'C 'y
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z By �. 54hfG G'/40a'7/f� Address ,2 .-19l`/��
3 CONTRACTOR,AGENT �I7v c / Q /
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ao State License (�'� 5 -Approved
U Ik PLUMBING INSPECTOR
FIXTURES J BER MAINDRAIN
UNITS FEES UNITS FEES
Warcr Hearer Size
Water Closets Matcdal
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
"skater Softeners Material
Bar Sinks To Main Drain
Comb. Sink i Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM t
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
8prinklcr Vaives Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete..
Main Drain
Final...