51015 Ide
NO. STREET
APPLICATION FOR PLUMBING PERMIT
w i 1 J•. ; �', �- ;,� SFJTY OF CUPERTINO
SanitaryNo.
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o < Date ��YI1 D 12r-/ 196-7 Permit No `s_� '0 /S—
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LL Fee $ -1 —
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� Af7�li�tionPis here�y made to the City of Cupertino for a permit to install plumbing
0w - ' 1 n•r [ YY
o a pipes nd/c�ufixhaesll� �Si�Ynithe1reversc side hereof, and agrees to install said Prices
I and/or fixtures in accordance wrth the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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a Use of Premises L-Cti12.f,v`
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3 Owner .��: . ��t�..,.. Address
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Byz/ /�. L L?C��2 �1 Address �l C l� O/�2r�t/�—C—G� Kw'
CONTRACTO[R, AG T /%,
w i Phone s
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u s State Lickenseens. Approved
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U PLUMBING INS ACTOR
FIXIURES
UNITS FEES UNITS FEES
'plater Heat< $i20
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
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains 3. ?'. WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee j �=
Area_Drains Main Drain Fee
Nater Leaders Storm Drain Fee
-pr,nklcr Valves Water Sys. Fee
Permit Fee
TOTAL " TOTAL FEE —cam
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final