51126 o?a2391 )6Y� J LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
wz a CITY OF CUPERTINO
�
a
r LL Sadtajy \'u. _
rc _
0 a Date _. 1961 022k No.
U
i a Fee $ !-
o Application is hereby made to the City of 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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all o r ws applicable r
LL Use of Premis
00
3 one Addres
z;
By Addres ,
3 0CONTR OR, EAT
— 0 Phone 731 1
w2
02
State LicensPS Q 3 D Approve
_U
ECI'OA
PLUMBING INSP
FIXTURESD BhR MAIN DRAIN
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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains Alan
Floor Drains I WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Zr/ater Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underg::ound Rough...
Partial Rough..
Rough. Complete-
.Main
omplete...Main Drain
Final._