NO PERMIT #LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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< Date '9'6— Permit No
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LL Fee $
o Application is hereby made to the City of Cupertino for a permit to install plumbing
0 pipes apd/or fixtuzes,listekq�, - reverse i
< erse side hereof, and agrees to install said prices
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>- H and/or fixtu'res', in'- acc'o'r'da-nQ-c w th: ffid provisions of the Plumbing Code of the City of
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_j LL Use of Premises
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�: Owner 0 < Address /,9� -71
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0 Se -7 State License Approve
PLUMBING INSPECTOR
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NUMBER
UNITS
FEES
UNITS
FEES
Water Heate
Size
Water
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
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
Floor Dra
,41s
WATER SYSTEM
Hopper
��
Size
Restaurant Sinks
Material
San Tra s)
TOTAL FEES
Fixture Fee
,
Area Drains
-Leaders
S70
Main Drain Fee
Water
Storm Drain Fee
rink) valves
Water Sys. Fee
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Per Feeon
TOTAL
11
TOTAL FEE
RECORD OF INSPECTION,,�qa_4,
Underground Rough
Partial Rough Q
Rough. Complete ! s
Main Drain
Final