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ICH �G_, r'I�"R / F.� Cr. D� LOT NO.
NO. STItEP.T
APPLICATION FOR PLUMBING PERMIT
z ` ��T O UPERTINO
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iitary No.
wo bate - �� Io ��Pennit No Pee $ Uy
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r Application is hereb made to the Cit of Cupertino for permit to install plumbing
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o a pipes and/or fixtures'. lated�n-thL' �y`'�' n,iereo( and agrees to install said prices
> r and/or fixtrlre5 in accordance with t In I wf the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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n Use of Premises
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r 3 Owner Address
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� z By Sn n�-,r ��Ev. •S B4,-y Address 73Y A ' iWdlecoO ()^
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CONTRACTOR, AG— GNB
- Phone 26 G- 6 2 3/
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a o State License Z &9� Approved
PLUMBING INSPECTOR
FIX DBER MAIN DRAIN
UNITS FEES UNITSI FEES
7Vatcr Heate Size
�Xrater 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
Com . Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains ain Drain Fee
Water Leaders Corm Drain Fee
-prinkler Vdt Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final
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