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-;'----,--,,APPLICATION.FOR PLUMBING PERMIT
:1 CITY OF CUPERTINO
`[ FG ( i9�' i Sanitary No.
Date JCLI196_ Permit Now/
fz ti • �,� ti,�, � _ Fee $ g ��
Applicationi-s�_lie�j�y�lia�le'So the City of Cupertino fora permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner/ Q V-
By it / C ` �✓ .5�9`J�
CONTRACTOR, AP ENT
Phone k .& QZ_:! :20 6
State Licenses 171
Address L// Z4% /l�c�ar�/Ci l7/
Add ress,r '0' Z/� _S-ze ./yC1 F PA
Approve Lo
PLUMBING INSPECTOR
L
FIXTURES
NUMBER
MAIN DRAI
UNITS
FEES
UNITS
FEES
Water Heate
Size
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
Wa! i Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant inks
Material
.Sand T
/
TOTAL FEES
r�als
Fixture Fee
dtea_Drains
Main Drain Fee
a�
Storm Drain Fee
SprinkIR Valves
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE 6—V
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough: Complete
:Main Drain
Final