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/� • LOT NO.
NO. STREET
AP_ PLICATION FOR PLUMBING PERMIT
�, = -CITY OF CUPERTINO
Sanitary No.
Date��� b'C �� �'S i196-7 Permit No..S�/y 6
Fee $�
Application is hereby made to the City of Cupertino for a permit to install plumbing
pip'& and/oDfixtures "I"''d�gn";thd reverse side hereof, and agrees to install said prices
V. and%ot fixtures in actor a e" with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises COTC f rr S A 0 /�
Owner 9�� In • Address Y
B �4�G, ,// Address �34 d4PS`ti�! 61
y r 0� or��GE T�^�--'� Sa c1o.tr G�aZ�/
Phone A 93'o!,_?6t<_ F
Approved
PLUMBING INSPECTOR
State Lice
FIXTURES
UM EMAIN
DRAIN
UNITS
FEES
UNITS
FEES
Water Heate
f
Size
Watei r 1 =its
°J
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 Drains
3
WATER SYSTEM
Hoppers
Size n
Restaurant Sinks
F=
Material
San Traps
TOTAL FEES
Urinals
--
Fixture Fee
�(
Area Drains
Main Drain Fee
Water
—
Storm Drain Fee
Sprinkler Valves
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE p p
RECORD OF INSPECTION
Underground Rough
Partial Rough
-Rough. Complete
Main Drain
Final