51001.2 Plumbing Application VI S+6 k VO l,(- POLY jL LOT NO. S 3
NO. STREET
APPLICATION FOR PLUMBING PERMIT
N
Z Z ® p UPERTINO
x o Sanitary No. _�'��
05 Date 81961k' Permit No 5'/0 0 y
U1 1 LU `
W Fee -9 y SC'
Application i r a Cupertino for a permit to install plumbing
o a pipes and/o(vt� tr es l fled ylQ i e e,, de hereof, and agrees to install said prices
r and/or fixtures In accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
W 2
J a Use of Premises
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3 Owner �LZ!� Ci2-- �� Address
_ Zwt�w
z By Address
3 CONTRACTOR, AGENT
- 0 Phone ag3 - �o� -7
a o State License c5' Approved /
\ T - KPLUMBING INSPECTOR v
FIXTURES NUN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size �
Water Closets 3 Material
Bath Tubs To Curb
Showers To Prop. Line )r-
Lavatories
<Lavatories To Existing
Kitchen Si s Not Conn.
ish Washers Sewer Boxes
Waste Disposals
as Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Denta Units 6.41
Dunking Fountains
,Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material A 1,t/
San raps TOTAL FEES
rinals Fixture Fee p
Area rains Main Drain.Fee 0 p
Water Leaders - Fee ,�p
Sprinkler Valves Water Sys. Fee
Permit Fee , pv
TOTAL / TOTAL FEE a y S
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...