51075.7 LOT .
NO. S ItEE.I'
N APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
z Z
_
' 0 ,f � � . Sanitary Nu. .
o Date 176— Permit No, L 7
w LL Fee S
� o
� Application is,hereb}'.made. to the City of Cupertino for a permit to install plumbing
0 pipes and/or fixtures listed on .the reverse side hereof, and agrees to install said prices
> r`- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thEreto.
w x
� r
Use of Premises
00
oa Ownery -a �`'�`�� Address
ZJ
z By Address/�'° � 7t,• �M.tK_
O CONTRACTOR, AGENT
3
— 0 Phone
W w
aa State License Approved
t,Jf PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
`.Vater Heate Size
Water Closets Material
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
is Washers Sewer Boxes
Waste Disposa s
\ as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
rel rains Main Drain Fee
eater Leaders Storm Drain Fee
1prinklcr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final