2553 (2) Q� SIJE.T
PPLIC�T
t1'iNOPLUMBING P
ERMITOwe RCUPERTINO
!JR 9964E a Sanitary \u.
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oD194Permit NoS
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3 U 1 Pee $
2 LL
Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse 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
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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r 3 Owner�s� �� /
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3 1 ONTR CTOR, AG.�s EN7 T
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a o ,State Licens/7� rte" Approved — —
�,u './ PLUMBING INSPECTOR
)FIXTURES NUMBER {
UNITS FEES UNITS FEES!
Water Heate Size .
Water Closets Material 1
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
;Dish Washers Sewer' Boxes
VNaste Disposals i
Wash Trays STORM DRAINAGE + .
P/ashing Machines 11 Size ' /0
Water Softeners Material
Bar Sinks To Main Drain
Cod . Sink a Trays To Curb
Dental Units=
Drir�=Fotrrttatns -
I°loor Drains WATER.SYSTEM
appers Size
'-Restaurant Sinks Material
=d Traps TOTAL FEES
Urinals Fixture Fee' d
Area Drains Main Drain Fee
Water Leaders 'Storm Drain Fee`
Sprinkler Valves Water Sys. Fee.
Permit Fee .p G
TOTAL TOTAL FEE 17,-J
RECORD OF INSPECTION
Underground Rough...
•PSrtial Rough.. -
Rnugh, Complete..
Main Drain -
Final...