51145 (2) LOT NO.
/I/f70 STREET
LTION FOR PLUMBING PERMIT
d �/UCITY OF CUPERTINO
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x o � �� Sanitary No.
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o a � (e 66 196 Permit No
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Application I de to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures n 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
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Cupertino, and all other laws applicabl thereto.
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Owner��_L(__/2 e Z/11 4 rt Address -,'1 /G oda
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02 State Livens Approved
u r I PLUMBING INSPECrO /
FIXTURES NUMBER I UKAIN
UNITS FEES UNITS1 FEES
Water Heater 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 m0 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
Sand Traps TOTAL FEES
Urinals Fixture Fee 1 .2,00
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Varves Water Sys. Fee
Permit Fee ,oU
TOTAL Ga TOTAL FEE 00
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
.Main Drain
Final...