NO PERMIT NUMBER LOT NO.
NO. STREET
r'"APPLICATI N FOR PLUMBING PERMIT
z < o � Y ° �CUPERTINO
Sanitary No.
3 a Date 1 iLZULi�3 permit No
U
Fee$
n w Applicaticn'is hcreby,made,foQlieG Cityt�, of Cupertino for a permit to install plumbing
o < pipe and/or fixtures listed on tliet Pe4r4e side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable- Iereto.
w x
r �
w Use of Premises
03 Owner � / AcIA'esl� 1� '�' �/i �///
zz By/ r Tom/ 72i'� Addres �C/
C TRACTOR, AGENT
3 <
— m Phone
W z
a o State License Approv
PLUMBING INSPECTOR
Y
FIXTURES D BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate 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
Wash-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink m Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee'
re-Drains Main Drain Fee
Water Storm Drain Fee
7-prinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 1V
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...