51068i01k7
LOT NO.
NO. STREET
APPLIC:A'T N FOR PLUMBING PERMIT
W Z ` TY OF CUPERTINO
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Y ° a r% 1, Sanitary No.
0 a Da 196- • Permit No.
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' ° +,1i'ppica n is�l�e9 bRINId�the City of Cupertino for a perLL m to install plumbing
o LL a pipes and/or fixtures listed on the revdrse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
WCupertino, and all other laws applicable thereto.
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a Use of Premises '
00
3 OwnerC Address
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0 F ed Address /70
CONTRACTOR, AGENT
3 (n Phone oZ' b O !f f
o State Licens 11 E f Approved a ✓��
_ U� PLUMBING INSPECTOR
FIXTURES
NUMBER
MAI
UNITS
FEES
UNITS
FEES
Water Heate
.ice
Size
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks ,
�'
/-S—D
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
Wash 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 Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Drains
Main Drain Fee
Tater Leaders
Storm Drain Fee
Sprinkler Valves
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough: Complete
Main Drain
Final .