51145 (4) LOT NO.
NO. STItEP.T
APPLICATION FOR PLUMBING PERMIT
.i i ® p Y OP QIPF.RTINO
x o Sanitary No.
oDate 6� Permit No
3u
iFee S 1 .7 =
O A io i he t City of Cupertino for a permit to install plumbing
o r pipe '"bi�ur�js + #� verse side hereof, and agrees to install said prices
> ` 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.
w 2 �
� r
., Use of Premises
00
> w
,- 3 Owner Address
o a CROWN BLUMBING CO. INCef
0 <
z }3}' Adds- sus O PLUMBING CO, lua
C 9-, AGENT OX 802
3 l Ort 1Cl
— m Phone � � Saratoga California
w z
w w
¢ a
u s State License Approved
a o
U!� PLUMBING INSPECTOR t�
FIX I uRhb NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
ffiSi
e Size
ets Material _L
Water
To Curb
To Prop. Line
To Existing
ks Not Conn.
sasers Sewer Boxes
Waste Disposals
Wash-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
bar Sinks To Main Drain
Com . Sin a rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material ,4 L
San raps TOTAL FEES
Urinals Fixture Fee a
rea rains Main Drain Fee
lVater Leaders Storm Drain Fee
_prinklcr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final