1784LOT NO.
NO. STREET
ftTION FOR PLUMBING PERMIT
®'6•� ITY OF CUPERTINO
rSEP6 1962 0 ` p�[r
to , 195_ Permit No. �o /
CITY OF Cyffi I10 Fee$
Application Is here y ma. e 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.
Pse of
I /
Owner.
By -j
Phone—
AGENT
/{E 97?OK /
Address / W af, e'
Address ati
Approve
PLUMBING INSPE rit
SURES NUMBER
MAIN DRAIN
1 UNITS I FEES
IUNITS I FEES
Water Hearer IUtI
Size
Water Closets 1
�� 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 100 6611
Size
Water Softeners / � y d0
�� Material � I
Bar Sinks
To Main Drain
Comb: Sink s.Trays
To Curb
Dental Units
Drinking Fountains)
2: -
Floor Drains (/p
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee itn
Area Drains
Main Draih Fee
Water Leaders
Storm Drain Fee
Spnnklcr Vaives
Water Sys. Fee o -b
Permit Fee0,0
TOTAL
�� TOTAL FEE OVU
RECORD OF INSPECTION