2276 ✓J 1.1GL4�', �..�t LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
iCITY OF CUPERTINO
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p Sanitary No..
3 a 'Dare . II19� Permit No
7
W LL Pee $
6,3- 00
O C�A'Pplicatibniis�?bb�—a8erto the City of Cupertino for a permit to install plumbing
o a pipes anrd)or fixtures'-fisted on the reverse side hereof, and agrees to install said prices
i to and/or fixtures in accordance with rovisions of the Plumbing Code of the City of
s w Cupertino, and all other law applica thereto.
0 Use of Pdemises
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CON A OR,AGENT
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ao State License / / �� Approved
PLUMBING INSPECTOR
FIXTURES M ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater �.00* Size �}
Water Closets 3,e7pMateria! y 0
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 3,00 To Existing 6---
Kitchen
/Kitchen Sinks ,00 Not Conn.
Dish Washers Server Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'sXlater Softeners Material
Bar Sinks - To Main Drain
Comb. Sink s Trays ,oO To Curb
Dental Units
Drinking Fountains /.00 '
Moor Drains f Op WATER SYSTEM
Hoppers Size .00
Restaurant Sinks. Material Vo1VLVj
San Traps TO AL FEES
Urinals CO Fixture Fee O
.Area Drains Main Drain Fee a2.0
Water Leaders 0 Storm Drain Fce
Jprinkler Vaives Water Sys. Fee /.CO
• Permit Fee
TOTAL i TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete
'Iain Drain Y.,..7 '»..�+ 63
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