51119 LOT NO
NO. STFYI'
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
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x o � Sanitary No.
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o are 1962 Permit No
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- o Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes fp f/(q�r tyre cl verse side hereof, and agrees to install said prices
> 1- and/ tftxEure ii ack'k a 'fi4 tjih provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
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Use of Premises
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3 Owner �-�' i Address 0 3Z'2z'2'
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a o State License �S�s-sr Approved
—U V PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITSI FEES
Water Heate O 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
IX/as'h Trays STORM DRAINAGE
Washing Machines Size
\�/ater Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
W—ater Leaders Storm Drain Fee
5prink1rr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 71
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final