51039 10 3 01 Asa.
LOT NO
NO. S T'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
195_ Permit No. d �Q
Fee $/. -On
Application is hereby made to 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
v
i�
Use of Premises a
a a j �. Ib -3 0 '
Owner Jphn A $ l i Z Address 1301 Pharlan Dr.
By CON
AddresslK 7/A f��i T
CON CTOR, AGENT
Phone Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITSFEES
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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material j
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains) II
Floor Drains WATER SYSTEM
Hoppers I Size
Restaurant Sinks r Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final