51046 (4) 10657 Rosewood
LOT NO,
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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Applicat i(� y d49 The f Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
Z N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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a Use of Premises 4-Plex
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o a Owner William White Address-3&jUaL-Pr" ndj Wg.}L
By Winchester Plumbing Co. Address 1217 Dell Ave.
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w z State License. C 210245 Approved
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I PLUMBING INSPECTOR �/
FI. R :5— NUMBER MAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Material Ca.t
Bath Tubs 41To Curb
Showers To Prop. Line
Lavatories ,Z, 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 pFixtureFee
SYSTEM
Hoppers L
Restaurant Sinks
San Traps OTAL FEES
Urinals ee Area Drains ain FeeWater Leaders /�!� rain FeeSprinkler Vaives s. FeeeeTOTAL (� FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
Main Drain
Final...