1321 7 ` I "�� l-ti LOT NO.
41TY
OV 1 ' �AFOR PLUMBING PERMIT
OF CUPERTINO
EaRjy nF ' �W, 19$-jLl Permit No. I Z
Fee $ S�
Application is hereby made 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.
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& Use of Premises b)ael C_e�
a n
Owner Address
BYH.y G�, °^. `�2.""`a Address
CONTRACTOR, AGENT
Phone �' 7- S60 9 Approved
PLUMBING INSPE OR
PIX URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater j j Size
Water Closets j jj Material
Bath Tubs To Curb j
Showers.. jj To Prop. Line
Lavatories j jj To Existing
Kitchen Sinks j j jj Not Conn.
Dish Washers j jj j j
Waste Disposals j j jj j
Wash Trays j j jj STORM DRAINAGE
Washing Machines j j jl Size
Water Softeners Material j
Bar Sinks j jj To Main Drain j
Comb. Sink a Trays j j jj To Curb
Dental Units
Drinking Fountains 9� II
Floor Drains j WATER SYSTEM
Hoppers Size
Restaurant Sinks j jj Material
Sand Traps TOTAL FEES
Urinals j j Fixture Fee
Area Drains j j jj Main Drain Fee j
Water Leaders jj Storm Drain Fee
Sprinkler Valves j II Water Sys. Fee
EWER BOXES Permit Fee
TOTAL j j jj TOTAL FEE i
RECORD OF INSPECTION
Partial Rough -.
Rough Complete
Final
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