51043.1 (6) z e kao Y'-S, <0, LOT NO.
NO. STRF.F.T
APPLICATION FOR PLUMBING PERMIT
e'PxH'1<Y�I�CUPERTINO
x o 1, ��� Sanitary No.
a L
O < Date C 19tt,! Permit No
3LL IMA`{ 6 Fee $ 7�
O Application hereby made to th City Cupertino for a permit to install plumbing
o a pipes and/or fixtures Irst d �+n �v}n ADdl e hereof, and agrees to install said prices
> . and/or fixtures in accWlancoJ ,ilh the provisions of the Plumbing Code of the City of
a w Cupertino, and. afltothcr Imus applicable thereto. ,
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Use of Premises
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, 3 Owner��. Address
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�z By /lX-A"c-a r%/ . Address
O 3 CONTRACTOR, AGENT
- `m Phone 3.rV- 2fs'D
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rc a S UJILLI.`..1: D. 6Di�1_VI:.::
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State License �� Approved
— 0 I` PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
VVas'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com F Si s Trays To Curb
Dental Units
Drin ing Fountains
I oor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
re DDrains Main Drain Fee 5—tf
Water Leaders Storm Drain Fee
7-prinkler Valves Water Sys. Fee
Permit Fee a-e
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final