51027.7 a39� -9-
LOT NO.
NO. STR F.P.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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0 < Date - Permit No SZO aZ 7, 7
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U LL Pee S
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App iorY?4 errrel , mfalito t11yof Cupertino for a permit to install plumbing
o w pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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and/ es�gtac���t�y� provisions of the Plumbing Code of the City of
a w Cuper nd of a Ic thereto.
a „ Use of Premises
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o a OwnerLOA 4, /YI Address
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By �il o� �u�'�"'� Address
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CONTRACTOR, AGENT
3 m Phone
a2 State License U / 7 Approved
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PLUMBING INSPECTOR
1
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size r/
Water Closets Material
Bath Tubs To Cu
Showers To Prop.
Lavatories To Existing
Kitchen Sinks (D Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners - Material M
Bar Sinks To ain Drain
.
om Sink m Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an raps dfad.;FOTAL FEES
rinals Fie-F 4° O ,$-o
r
rea rains Main Drain Fee OU
Water Leaders Storm Drain Fee
Jprinklcr Valves Water $y5. Fee
Permit Fee ap
TOTAL ;t :Z TOTAL FEE S Q
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final