NO PERMIT NUMBER /o Q
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APPLICATION FOR PLUMBING PERMIT
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4� ' .IT �CUPERTINO
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Sanitary No.
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3 a Date 19 ' Permit No
45U
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LL Fee .S
° Applicatr)_is here madelte� t "r Cupertino for a permit to install plumbing
'o < pipes and/br,fiistt�re`slhsted�efnttlSefr`ohhiiA_kide hereof, and agrees to install said prices
> 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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Owner CZ /..+ /LY"� �� �,a�c. Address �G�yy�
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3 F CONTRACTOR, AGENT'
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a o State License Approved WILLIAM D.
U�d 1 Jr•3cl'y 7-- PLUMBING INSPECTOR
-FIXTURES NUIN, BER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Hcate Size
Water Closets 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 s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final 2 i