51117 / L
STREF. OT NO.
! APRAPgL"TIrFOR PLUMBING PERMIT
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CUPERTINO
ro U Sanitary No. _
3 a Dat TINg96-,b Permit No
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W � Fee $
° 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
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and a of er aws appli le hecto.
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LL Use of Premise
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3 Owner ddress d
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z B Address
° .NTRACCOR A NT
3 �
- 0 P c�- D
aU State Licen�'i:. 0 � /z3 Approved
1 /7J AZ PLUMBING INSPECTOR
FIX-1 URES NUMBER
UNITS FEES UNITS FEES
Water Heate 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
as'h Trays STORM DRAINAGE
Washing Machines C Size
Water—Softeners / Material
Bar Sinks To Main Drain
ComU-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
rea Drains Main Drain Fee
ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee —�
TOTAL i TOTAL FEE
RECOR OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete-
.Main
omplete...Main Drain
Final...