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LOT NO.
NO. STREF.t'
;APPLICATION FOR PLUMBING PERMIT
w ` ��J `� N_ Irk 6ITY OF CUPERTINO f�
y p I'� Sanitary \0. /
o 1 I)a[c ' rEg �Z' kK; 4196 Permit Nn. �11�
a
w Pee $ 40"
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LL w rApjll'icafbn isfNeMb,I ,cll4,to,'�the City of Cupertino for a permit to install plumbing
0 `a pipes and hxtuie 1 n t6 reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
., Use of Premises Com, klla,04 "
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o0 3 Owner� nn e+�_ Address
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O CONTRACTOR, AGENT
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State License ItApproved-
U � / PLUMBING INSPECTOR ✓
FIXTURES NU
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material C/
Bath Tubs To Curb
Showers To Prop. Line t,—
Lavatories
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
Com . Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size 1 41 Z
�
Restaurant Sinks Material 1941 —
San Traps g �q TOTAL FEES
Urinals Fixture Fee
A��r�ea Drains in Drain Fee
y
W Ater Leaders _ - i ee /
Sp okler Val.-cs Water Sys. Fee
c.. / , o''V Permit Fee
TOTA pp TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .
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LOT
NO. STREET'
A•PPL CATION FOR PLUMBING PERMIT
C:_ITY OF CUPERTINO
1 Sanitary No.
Ij
Date-� ' �—L � :� ! �7 L111""i",
196— Permit No. as"I I
Fee
AppPccatio=,is }iecebg�adel o the City of Cupertino for a permit to install plumbing
pipes and/or''lfixtdrestlis`i d. on4the reverse side hereof, and agrees to install said prices
and/or fixture
Cupertino,
Use of Pre ' a her cordance with the provisions of the Plumbing Code of the City of
law applicab reto.
r �R V1iAS�
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%SoQ A 0k%gectA7A&ess
By "It MIA TT -5,&G Llt� E I Addres
CONTRACTOR, AGENT
Phoned A 1
State LicenseCA Appro�
STOM E W.
PLUMBING
FIXTURES--NLY1NI
E
UNITS
FEES
UNITS
FEES
Water Heate
Size
Water Closets
Material
Bath Tubs
To Curb
Showers
j 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 & Trays
To Curb
Dental Units
Drinking Fountains
Floor Drains
WATE�SYSEM
Size
Hoppers
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
.
Area Drains
Main Drain Fee
alter Leaders
Storm Drain Fee
der Valves
Water Sys. Fee
Permit Fee
7.Vp
7
TOTAL FEE
&% jUVOR
=NSPECTION
_
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final