51125 (2) -2 SraNv D ?lr LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
z
r o Sanitary No
0 U Date / 196 420—=t No `r�� a `r
w Fee $
0 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
<w Cupertino, and all other laws applicable thereto.
Use of Premises a S
oo
3 Owner e 6 0 IC 'l' t 1 5 O N Address
z BySIU6g.1 'Vmt'6l N6 1. G Address /07-of- ( Ce,�
O RACTOR,AGENT .
3 P -
- 0 Phone—L-15 -I-
w Z
a o State License 3 Approved
_U - PLUMBING INSPECTOR
PIXTURES
UNITS FEES UNITS FEES
Water Heate Size A4 I
Water Closets 3 Material
Bath Tubs ( To Curb
Showers To Prop. Line
Lavatories j To Existing
Kitchen Sinks Not Conn.
Dish Washers / Sewer Boxes
Waste Disposals r
Wash Trays STORM DRAINAGE
Washing Machines ( Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains I
Floor Drains WATER.SYSTEM'
Hoppers Size
Restaurant Sinks Material
SancT Traps TOIRL FEES
Urinals Fixture Fee'
Area Drains Main Drain Fee UU
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee aiD
Permit Fee
TOTAL / 11 TOTAL FEE 11hQO
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough, Complete-
Main Drain
Final.--