51075.1 (3) / I - LOT NO
NO. STREET -
'APPLICATION FOR PLUMBING PERMIT
'-CITY OF CUPERTINO
Date Permit— 6 /I��T �.,1 19� Permit No. J� /0 7.� .
— 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.
8 Use of Premises
2 Address
" T11VW PLUMBING CO.
gy4045 7r, t�. Address
Palo Alto, CafPV,;tfi A, AGENT —
�Alt_ 1 Approved
Pho hPne. 328 67?S �� PLUMBING INSPECTOR
--TI=UR S —NUMBERM I R N
UNITS FEES UNITSFEES
Watcr Hcatnr Size
Water Closets I �� Material
Bath Tubs To Curb
Showers l l ll To Prop. Line
Lavatories l l ll To Existing l
Kitchen Sinks Not Conn.
Dish Washers ll l
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines l . II Size l
Water Softeners ,&jg�Slj Material l
Bar Sinks l ll To Main Drain
Comb. Sink s Traysl 1ll To Curb
Dental Units l l l
Drinking Fountainsl l q _
Floor Drains l ll WATER SYSTEM
Hoppers l �l Size l
Restaurant Sinks Material l l
Sand Traps l l ll TOTAL FEES
Urinals Fixture Fee 1.
Area Drains l l ll Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves l I Water Sys. Fee l
Permit Fee -2-00
TOTAL l ll TOTAL FEE
RECORD OF INSPECTION , S�
Partial Rough
Rough Complete
Final