2051 �-I" / _ .
_ LOT NO. ,T_
NO.� STR JJ F
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APPLATION FOR PLUMBING PERMIT
w z MAY I 19WTYj�OE CUPERTINO
x aSanitary No.
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o J Date MTV OFfel IDCDT'jq'6-- Permit No -2rl!�z
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Pee $ Y
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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
a w Cupertino, and all tie laws applicable thereto
a Use of Premises may"
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3 Owner �� �- R^^�°�d Address 7-e'-1 SI SNC
Z� o By 1` A,(z `I �\ a k-f O S Address F Cry
F CONTRACTOR, AGENT
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— Phone.
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ao State License I 9 Q( Approved
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PLUMBING INSPECTOR
1 1, URNUMBER MAIN R
_ UNITS FEES UNITS FEES
Water Heater 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
\\gashing Machines Size
Water Softeners Material
Liar Sinks To Main Drain
Comb—Sink c Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee pt.�
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Spr; kler Vmves Water Sys. Fee
gp Permit Fee
,TOTAL TOTAL FEE ,
RECORD OF INSP� (�N
Underground Rough..=/- ,3
.Partial mpRough..
.Rough- Colete..
Main Drain
Final...