51068 02 0 os/ & A LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
w2 CITY OF CUPERTINO
o Sanitary No. p
o Date 'GV ' ..• --'y 6-2 Permit No �
3 u` t;
Pee $ 4 Q
Appli �o e e � to d}' of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said Prices
> and o es�{t ac provisions of the PlumbingCode of the City of
a w Cuper nd bi ot1,y¢)�i i�lli�bC thereto. }
w x
Use of Premises -t;I E'rTj/r of frc r'
00
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Owner. • Address �e J / -}
a BV /J +fj��♦ Com, �y �."�`+'�Address )30 �i�e lyul d SU.
n CONl'RACTOR, AGENT
3 ` X93- �3yo
- `m Phone
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of State License�9��/� Approved- �(
a o
UPLUMBING INSPECTOR
FIXTURES
UNITS I FEES UNITSI FEES
Water Heate Size
Tate, Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks 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 0"0
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee o2c�!P
TOTAL TOTAL FEE o
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final