51037 Plumbing Permit LOT NO. /O
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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r oSanitary No.
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o a Date - S 196—`'/' Perrfilt No
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W LL Fee $
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� 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
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.
00 Use of Premises �
. 3 Owner Address /�`�'� 6�
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CO RACTOR, GENT
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a f State License zz G Approved
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—0 PLUMBING INSPECTOR
FIXTURES NU BER MAINT
UNITS FEES UNITS FEES
Water Heate Size
Wate, Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays / STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units '
Drinking Fountains
H-Drains
rains WATER.SYSTEM
Size
nt Sinks Material
aps TOTAL FEES
Fixture Fee' O'0
ains Main Drain Fee
eaders Storm Drain Fee
Valves Water Sys. Fee
Permit Fee
TOTAL FEE , o'U
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
-lain Drain
Final...
LOT NO. X16 S
NO. El'
NR PLUMBING PERMIT
d IT .
1 CUPFRTINO
w SEP 5 196
x Sanitary Satrvy `u.
0 a Date Permit No
10 0
CIT OF COPE Tti� Fee $s
r ° Application is hereby made to the City of Cupertino for a permit to install plumbing"
`opipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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r r
4 Use of Premises yJ
00
r 3 Owner
Address
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J , By Address
O CONTRACTOR, AGENT
- V-12- 34.f7
z Phone
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I State License N�/0 Approved
o
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pro . Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader- Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee d"0
Total Total Fee Q