51107.1J'� '�—�
LOT NO.
APPLICATION FOR PLUMBING PERMIT
(a �� ram; CITY OF CUPERTINO
- V, i 19 Permit No.
G� U
Fee $
\ P ' --'Application'IY ereby f made to the City of Cupertino for a 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.
w
Use of Premises
a C-) D �'. o" .
c, Ow�ne� Address
By / 1 Address
CONTRACTOR, AGENT
Phone Approved
PLUMBING INSPECTOR
FIXTURES NUMBER
MAIN DRAIN
UNITS
FEES
I
UNITS
FEES
Water Heater / I
II
Size ,Slit
Water Closets
Material&/g
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
I To Existing.
Kitchen Sinks
Not Conn.
Dish Washers
iI
Waste Disposals I
II
Wash Trays
STORM DRAINAGE
Washing Machines
/
II Size
Water Softeners
�� Material
I
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
I
I
Floor Drains
�� WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
I
I TOTAL FEES
1, z�—°
Urinals
I
II Fixture Fee
149
Area Drains
Main Drain Fee
I
Water Leaders
Storm Drain Fee
I
Sprinkler Valves
I
I
II Water Sys. Fee
I
II Permit Fee
TOTAL
I
TOTAL FEE
RECORD OF INSPECTION'
Partial Rough
Rough Complete
Final