100052 No. STREET
APPLICATION FOR PLUMBING PERMIT
z ` —.1 --� CITY OF CUPERTINO
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Sanitary No.
On
- Date � 196— Permit No, O
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w Application is hereby made to the City of Cupertino for a permit to install plumbing
0 pipesandrfor fixtores,listed"onithe reverse side hereof, and agrees to install said prices
> afid%X fiztures 'in nccordhnec'w,ith the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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0 3 Owner Address /I
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O CONTRACTOR, AGENT-,-
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GENT-/30 PhoneX `727,x–
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0 s State License K Approved /
U PLUMBING INSPECTOR /
FI. I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heart 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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink u Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOT* FEES
Urinals Fixtwe Fee
Arca Drains Main Drain Fee
mater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee ��"
TOTAL TOTAL FEE 3 4
RECORD OF INSPECTION
[—Rough
nderground Rough
rtial Rough
. Complete
ain Drain
inal