51046 (3) /O �V �' ( Rosewood LOT NO. v /
NO. STI EF.I'
APPLICATION FOR PLUMBING PERMIT
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Z CITY OF CUPERTINO
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x o . Sanitary No.
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0 a Date / Permit No
3 0 SMA 25 19§7 Fee S� `r0
Apphcat'ion is ereby ma e to lity, of Cupertino for a permit to install plumbing
0 pipes and/or fixtures listed on the reverse side hereof, and agrees to installsaid prices
and/o es(WacQ i provisions of the Plumbing Code of the City of
i w CuperndMfl otHl R le thereto.
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Use of Premises Laundry room
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Owner am White Address365 La Prenda Way
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ZJ1217 Dell Ave.
Z By Winchester Plumbing Address
o CONTRACTOR,AGENT
- 0 Phone 378-7615
W C210245
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State License Approved /
U 1� PLUMBING INSPECTOR V
FIXTURES M E MAIN DRAIN
UNITS FEES UNITS FRES
Water Heater Size
Water Closets Ma'erral
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
Vrater Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
r San Traps TOTAL FEES
Urinals Fixture Pee
Area Drains- Main Drain Fee
\hater Leaders3MWDram Fee 3
Sprinkler V.iwes Water Sys. Fee
Permit Fee Z O U
TOTAL TOTAL FEE / A
RECORD OF INSPECTION
Underground Rough...
Partial Rnugh..
.Rough. Complete..
Main Drain
Final...