100096 14&/ � / LOT NO,
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eA�P�PLE! ATION FOR PLUMBING PERMIT
a ® /o ! CITY OP CUPF,RTINO
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o a I)at JUN gn 96— Permit No A) 0 D
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QTycaq is ereby made to the City of Cupertino for a permit to install Plumbing
o pipes and (it the reverse side hereof, and agrees to install said prices
> : and/or fixtures in ac'cbr1gh the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws a,plicable thereto.
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Use of Premises
oa Owner %�� Address 11'0166+P_
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CONTRACTOR, AGENT
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° a State License Approved
U,,I PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Hcate 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
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Volvcs Wafer Sys. Fee
Permit Fee _5_ "
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alain Drain
Final