NO PERMIT NUMBER ,ZGGrs I {/ V 9A ei. Ct" LOT NO.
` NO. ST'I'R E F.I' ��—
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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� S:miciry No.o , Date I V� Permit No
3U NO1970 FCC S C �
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
" i>e i�r r• lI verse side hereof, and agrees to install said rices
and vkir n at�J�3 ���e provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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O CONTRACTOR, AGENT
3Phone A 96— /0S
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as State License .13S AA, Approved
U I PLUMBING INSPECTOR
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FIXTURES
UNITS FEES UNITS FEES
.Water Hcate Size
Water Closets Material
Hath Tubs �(6- 7 To Curb
Showers5 M 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 v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
-4VM4
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
�t rea Drains Main Drain Fee
\Vater Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
J1ain Drai
Finn
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