51039 LOT NO.
NO. STREET IV
APPLICATION FOR PLUMBING PERMIT
z a CITY OF CUPERTINO
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r o Sanitary No.
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0 a Date - 6X Permit No S/ 39,
W 1966 Fee $
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� (yati is hereby made to the City of Cupertino for a permit to install plumbing
o pi dd/�Fixt on the reverse side hereof, and agrees to install said prices
and/or fixtures iz T/NP the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws licable thereto.
W Use of Premises00
3 Owner (o/X !�'y�_ �,.�-Ci i,a� Address 14
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- 0 Phone -.1- �'' O 70,E
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40 State License O / /�S Appro
U PLUMBING INSPECT ✓
FIXTURES NU,%, BER MAIN DRAIN
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 11 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners f Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains AMN
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee / Op
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee lO0
Permit Fee OQ
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
Main Drain
Final...