NO PERMIT NUMBER (3) /o6P9 I �a *a _ LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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Y o T [8T No.
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3u DateVtn �9'A&8 �r� t Nov
w n p Fee $ �i
O Application is hereby rjade�� t ercitY" 1 Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed bri'th severs yt�tRTgj(�nd agrees to install said prices
a and/or fixtures in accordance with the provisions of tfirPlumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises lYkaR AAA- 0.
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3 Owne `r L,,m.� D-Q-Address 1 0
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By Q, Q �>\nJ� Address — '�j' r�/✓rt,_
3 < CONTRACLOR, AGE
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State License n Approved
U PLUMBING INSPECTOR
FIXURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heim Size
Water 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 . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee a [)
Area Drains Main Drain Fee
r/�- ater Leaders Storm Drain Fee
Sprinkler Vows Water Sys. Fee (�
Permit Fee _
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...