51001.2 LOT NO. •7 y' ��9n/ JL'/>
NO., $TRF.F.I' /
APPLICATION FOR PLUMBING PERMIT
z e Y OP CUPERTIN
y O ++Y.� Sanitary IjNIL ��3
—aH J
0 j Date �? I Permit No
a
UL!Ui a 7 Fee $-3
0 Applic�iyc�p s h reby made to the City of Cupertino for a permit to install plumbing
0 i es and/bJ �xtu',r„Z�--lis�Qj 't rev c side hereof, and agrees to install said rices
and/or fixtures in accord!"'u 4rithltliG��Ovisions of the Plumbing Code Of the Gty OC
a w Cupertino, and all other laws applicable thereto.
w x
n Use of Premises
0 0
3 Owner�1 _ (i�a� Ali Address,
ozBy C '�.��� Address
CONTRACTOR, AGENT
3 N
Phone'2� - 77
�.9� 9d�
a o State License Approved
U PLUMBING INSPECTOR
C/
FIXTURES b
UNITS FEES UNITS FEES
Water Heme Size
Water Closets �3 Material CC:
Bath Tubs To Curb
Showers To Prop. Line
Lavatories ,j To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals ,e F
Wash Trays ST9kM—HRAINAGE
Washing Machines Size 'r
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers SizeTW
Restaurant Sinks Material �, J
San Traps TOTAL FEES
Urinals Fixture Fee ,r/,o0
Area Drains Main Drain Fee
hater Leaders Storm-DFain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 2 r pv
TOTAL TOTAL FEE /,ems
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final