51145 (3) ILOT NO.
NO.
APPLICATION FOR PLUMBING PERMIT
d CITY OP CUPGRTINO
x_ _ Ll 7i
o q Sanitary Nn,
M
j Date ~P� r�`� ;196— Permit No�'
3 u66
w LL Pee $
� o
TI-ca(�JI'is�p made to the City of Cupertino for a permit to install plumbing
o r pipes and/ fix f5� { p I c reverse side hereof, and agrees to install said prices
r and/or fixtures in accorih ��f i the provisions of the Plumbing Code of the City of
<w Cupertino, and all oth ws a Ilicable thereto.
w x
r J 4
Use of Premises
0
5 w h, Address
, 3 Owner
O JDy rr
Address- CS�
z z
o CONT CTOR, AGENT
— a 3 7% < 0
z `
Phone
w z
ao. State License Approved
U // PLUMBING INSPECTOR
FIXTURES J
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was? Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size •
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee N
W,ter Leaders Storm Drain Fee
tTmklcr Valves Water $y5. Fee '
Permit Fee O
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final