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LOT NO.�—�
NO. STREET
APPLICATION FOR PLUMBING PERMIT
1�,QITY OF CUPERT
�I , anitary
Date � �� ,f.'196_ Permit No. 1 0 �O✓
� Fee $
pip P a d/ni ixt res$bl t ' oW� -q reverlication is here made to the se side heof rino for eof, andaagreesi tooinstall
install prices g
and/fixtures in-kcordance�Mf the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner
Address
By "A 14- /.�-�• iL Address
CONTRACTOR, AGENT
Phoney � ��- (�� 3 7
State License. Approved—a=4-�
j� PLUMBING INSPECTOR
FIXTURES
M
UNITS
FEES
UNITS
FEES
Water Heate
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 & Trays
To Curb
Dental Units
Drinking Fountains
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand 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
Main Drain
Final -