51125 (2) /O 3 3-S V"'� - LOT NO.
NO, STr
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
19566 Permit No. J Z
01 10 � Fee $ 4.00
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10 II�� s(h�{ �L he City of Cupertino for a permit to install plumbing
q p0Td Ffi 1,s Wed t e reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
v Cupertino, and all other laws applicable thereto.
Use of Premises
v
Owner Richard K. Hose Address 10335 Stonydale Dr.
ByRAFAEAddress 243B Moffett Blvd
Phone 967-4545 _ Approved
PLUMBING INSPECTOR
—FIXTURES NUM13ER MAIN DRAIN
UNITS FEES UNITSFEES
Water Heater I Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays II STORM DRAINAGE
Washing Machines Size
Water Softeners j1 4,0()JI Material
Bar Sinks To Main Drain
Comb. Sink n Traysl To Curb
Dental Units
Drinking Fountainsl
Floor Drains I I WATER SYSTEM
--ffo—ppersl 1 11 Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee I
Area Drains Main Drain Fee I
Water Leaders Storm Drain Fee I
Sprinkler Vaives I Water Sys. Fee
l� Permit Fee
TOTAL II TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final