51001.2 A).2 / / I(//e hh &20-I` glilc: • LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
� r CITY OF CUPERTINO
Date '�'-'i k S Permit No. 0 0 � �-
3..5�
MAR 13 1168 Fee $ -
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures istedd on the reverse side hereof, and agrees to install said prices
and/o__i7ri{Tre�t¢Xf provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Ow/n/er�1�LrY�LOJv���77t'�L 2LGy r x Address JOS 9 7UC Gc is�Q
gyC CC/ l t/L Address .5BD�f
CONTRACTOR, AGENT
i
/ Phon — APProvM(�
7� PLUMBING INSPECTOR
---FIXTURES I NUMBER 11 MAIN DRAIN
UNITS I FEES 11 JUNITS1 FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories I To Existing
Kitchen Sinks I Not Conn.
Dish Washers II
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountainsl III _
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals I I Fixture Fee
Area Drains I I I Main Drain Fee
Water Leaders I Storm Drain Fee
Sprinkler Varves I Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final