51027.7 (9) izr a � f LOT Njl�L.CL/`-'
NO. STREET
APPLICATION FOR PLUMBING PERMIT
z Y OF CUPERTINO
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r o ® Sanitary No.
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3 J Date I 6— Permit No.
a1) 1jUU �
a
i LL Fee $ —
O A io i he c to the Ci of Cupertino fora permit to install plumbing
o pipe r i or� tur l I Tlfi�verrsc side hereof, and arees to install sid prices
> r and/or fixtures m accordance wrth le provisions u( the Plumn ode of the City,of
a w Cupertino, and all other la pp able thereto. Qj,32 /7
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J 4 Use of Premises
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0 r 3 Owner ,Q Address /
o By / �0�i MrAddress 4,1
-� CONTAACTOA, AGENNT_
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a o State License ho Approved
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PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Hcatc Size
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dis Washers Sewer Boxes
Waste Disposals
aih Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drin ing Fountains
12 oor Drains WATER.SYSTEM
oppers ize
Restaurant Sinks Material
an T Tr-aps TOTAL FEES
Urinals Fixture Fee
rea fTrams Main Drain Fee
VVWater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 6-0
TOTAL , TOTAL FEE 6c)
R CORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final