51001.2 T LOT NO.
NO. S"EE.I'
APPLICATION FOR PLUMBING PERMIT
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2 Sanitary No. 47e5;J 7
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Date 'In I Permit No
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LL w Applicdt i!i�Mrttebl� �a���th ify�of Cupertino for a permit to install plumbing
0 < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i I and/or � in accordance with the provisions of the Plumbing Code of the City of
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Cope rtm n a0ncUPERTMID thereto.
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O CONTRACTOR,AGENT
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k9:31 Approved
D. L'ENCVICH
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PLUMBING INSPECTOR ✓�
FIXTURES NUMBER
UNITS FEES UNITS FEES
Water Heate i Size
Water Closets ,i Material
Bath Tubs j To Curb
Showers j. To Prop. Line
Lavatories S To Existing
Kitchen Sinks j Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee p o
Area Drains Main Drain Fee ,00
sU�--ater Leaders SW444Imin Fee l j-v
Sprinkler Valves Water Sys. Fee ,.Fo
Permit Fee
TOTAL i5! TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final