51027.7 (4) p3 90 � � �L—YPT Nn.
NO. STREET
PPLICA QN FOR PLUMBING PERMIT
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YON CUPF.RTINO
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1. yo E C 13 1965 s""""r N
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0 Date 196— Permit N
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U CITYFee
0 ApplicaPirn isgi)p RTJXQ
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 prires
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all of erLlaws/ applicable thereto.
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w Use of Premises
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3 Owner Address Civ
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0 Address
3 rCONTRACTOR,AGENT
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ao State License f�C S 7 ��� Approved w
-U PLUMBING INSPECTOR v
HXTURES NUMBER MAIN DRAIN
UNITS FEES r UNITS FEES
Water Hente CZ Size
Water Closets oZ ,643 Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories ,� To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
rias-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com ink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATERS STEM
Hoppers Size
Restaurant Sinks Materia p
San raps TOTAL FEES
Urinals Fixture Fee �.
Area Drains Main Drain Fee 7_!rO
WIater Leaders Storm Drain Fee
Sprtnkl,j Valves Water Sys. Fee cd
Permit Fee
TOTAL TOTAL FEE
RECORb OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final