51107.1? +CL( LOT NO. /O
NO. Sf&EET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Permit No.
") `I ! [- �i 15 -7 �, Fee $ C
`, j _. —I
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes ;and/or )fixtutes.,Iistdd; on the reverse side hereof, and agrees to install said prices
'aa. V
and/or fixtures' inL accordance with the provisions of the Plumbing Code of -the City of
\ Cupertino, and all other laws applicable thereto.
V Use of Premises r�
own�A� �1/�yij�k �oRis�s Addressi/
By��/�.(C� r Cv f Addresses-�4�9
Approved L�
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS
FEES
UNITS
FEES
Water Heater
Size
Water Closets
Material ' , 1��
Bath Tubs
To Curb
Showers
jj
To Prop. Line
Lavatories I
j �I
To Existing.
Kitchen Sinks
Not Conn. j
Dish Washers
Waste Disposals
j
j II
Wash Trays
STORM DRAINAGE
Washing Machines
I
j jl Size
Water Softeners
Material
j
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
j
I II
Floor Drains
WATER SYSTEM
Hoppers
I �j Size
Restaurant Sinks
j
j �� Material j
Sand Traps
I �j FPS TOTAL FEES ,.
Urinals
I
I I� Fixture Fee
Area Drains
j
I II Main Drain Fee
Water Leaders
I
j �j Storm Drain Fee
Sprinkler Valves I
I II Water Sys. Fee
/?
t 6�� Permit Fee
v-0
TOTAL
TOTAL FEE /mil
RECORD OF INSPECTION
Partial Rough f .4L:-
Rough Complete
Final