51145 (3) LOTNn.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
a � TY OF CUPERTINO
Sanitary10.
KLL
o a Dnte �� DI'564 Permit No
MAY 31 IJb6 i LL Fee $�'Itl Old
o Application is hereby,made to the City of Cupertino for a permit to install plumbing
o i e ��''pr �Trc i � T verse side hereof, and agrees to install said rices
> and/ xtra2s�tn 11 afR- with�the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
0 LL Use of Premises
00
3 Owner Address
OJ
BCROWN PLUMBING co/wc. AddCeB sO PLTJMBING CO. INC.
J L
O AGENT OX
— z Phone
Saratoga, Califcrnia ` '^' oa. Californin
w z
pa ? � oyoy
u F State License Approved
a o
U 'I PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Sae
Water Closets Material Q T
bath Tubs . To Cu
Showers To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
bar Sinks To Main Drain
Com . Sink s rays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material L•ISan Traps TOTAL FEES
rinals Fixture Fee 01)
rea rains Main Drain Fee o V
Water Leaders Storm Drain Fee
Jr.rinkler VJ e- Water Sys. Fee cr'
Permit Fee
TOTAL TOTAL FEE (yv
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final