51119 1 6-11- V6el9A9 LOT NO.
NO, STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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x o p Sanitary \'o,
0 Uaye 1965Q Permit No
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w w /JUN q Fee $
= 0 2 p
Application is t�rUB'}�hfad e City of Cupertino for a permit to install Plumbing
o w p and/or fixtures hsted on e reverse side hereof, and agrees to install said rices
> r YfijD jn�'�y� ante with the provisions of the Plumbing Code of the City of
a w Cupertino, nd A U�tieJ'�-61�plicable thereto.
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3 Owner r *'7 Address LO e/ttt
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By A f7N Address-
0 CONTRACTOR, AGENT
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Phoney
ZSz-02-51
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0 s State License Approved
PLUMBING INSPECTOR
FIXTURES NUMBER
UNLTA FEES UNITS FEES
Water Heatc Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposals
rill Trays STORM DRAINAGE
Washing Machines + Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays - ' To Curb
Dental Units
Drinking Fountains
Tloor Drains WATER SYSTEM
Hoppers ze
Restaurant Sinks Material
San raps TOTAL FEES
t'
rina s Fixture Fee
rea rains Main Drain Fee
r/�- ater Leaders Storm Drain Fee
;prinklrr Volvice Water Sys. Fee d�
Permit Fee d-a
TOTAL TOTAL FEE aa.
RECORD OF INSPECTION 5e 40-
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final