571 .�-, �, LOT,,o. _NO. - STREET
Xi �7pfp�LI TION FOR PLUMBING .PERMIT
CITY OF CUPERTINO
t��ht I 195 Permit No.
pD
�FF �` y��f�,, Fee$
plil at on'i's`h t b -fh�tl8 fo the City of Cupertino for a permit to install plumbing
J°JJ 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.
Use of Premises �u'c A41�c
Owner /�s�� /7cz� c ri Address_f'�9
Byii R Address d '�
' coNTnwcr nceNr c
Phone�X- �-�>7 F-3 - Approv l
FLUMBING INSPECTOR
I
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers Prop. Line
Lavatories To Existin
Kitchen Sinks
D+ch Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines 1I Size
Water Softeners I Material
Bar Sinks To Main Drain
Comb. Sink & Traysl 1 II To Curb I I
'Dental Units
Drinking Fountamsl
PM
Floor Drains 11 WATER SYSTEM
Hoppers II Size
Restaurant Sinks 1I Material I �•I,
Sano Traps II' TOTAL ES
UrinalsI 1 11 Fixture Fee
Area Drains I II Main Drain Fee 10
Water Leaders Storm Drain Fee ,
Sprinkler Valves I Water Sys. Fee ' I / o a
Permit Fee / od
TOTAL - TOTAL tLE
RECORL) OFf NSPECTION
Partial Rough _
Rough Complete p
Fin.