51145 (3) .0� �" ILOT NO. arc
O "_ SC
N APPLICATION FOR PLUMBING PERMIT
a ?JAN
L;ITY OP CUPERTINO
fo 1. 3 194 Sanitar , INo.0jI y
0 � Date � 196 Permit No .�/V1�
3U
Fee $
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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 X.IS. �. �✓. L.
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3 Owner-
0 Address
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z By 11f7 Address a Z
CONT (-TOR, AGENT
3 o Phone 3 7,9
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a o State License d �l r7 y�7 Approved
U PLUMBING INSPECTOR
I,lX I U RES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material C,?
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
\�/atet Softeners Material
Bar Sinks To Main Drain
Com . Sink & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material(pop
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee 00
Water Leaders Storm Drain Fee
Sptinkler Valves Water Sys. Fee 00
Permit Fee of
TOTAL TOTAL FEE p
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Vtain Drain
Final