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STREF.PPLICA.T.IONRPLUMBING PERMIT
41A1 .s 'NR
'IT !CUPGRTINO
r o Sanitary No. _
3U7 /�F �� �rryj'�jfa �J
o a 'Date t' "- •• �t CR 196 Permit No
i `o �. Pee $
Application is hereby' made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto. ,
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� LL . Use of Premises;
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3 Ownee. tri ' Addressr C < �-(.�'..ui
z Address ` rI
_ CONTRACTOR,AGENT s '
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State Licens �� Approved
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PLUMBING INSPECTOR
- - «,
FIXTURES NUIN BER MAIN DRAIN .
UNITS FEES UNITS `FEES,
Water Hearer Size
Water Closets '�- Materia;
Bath Tubs To Curb
Showers To Prop. Line
Lavatories t2_— To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Tiays STORM DRAINAGE
Crashing Machines Size
.Cater Softeners Material
Bar Sinks', To Main Drain
Comb. Sink s Traysl To Curb
Dental Units
Drinking Fountainsr "-
Floor Drains WATER SYSTEM
Hoppers f Size
Restaurant Sinks Material
Sang—Traps TOTAL EFS
Urinals - Fixture Fee
Area Drains Main Drain Fee , y0
Water Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee
Permit Fee &-V
TOTAL TOTAL FEE
R •CORD OF INSPECTION
Underground Rough_.
,Partial Rough..
Rough Complete..
.VIiin Drain
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