1003 LOT NO.
NO. STREET
PL CATION FOR PLUMBING PERMIT ''"
® CITY OF CUPERTINO
�, t 196-0- Permit No.
f /� T ❑C T�eI/� q
Hl CI AYp1iQ6on§SUPERdiitf Q the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
Do and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto./��o /G 1\ t�
8 Use of Premises--S S 1 D 4SA/ C E
'a
Owner 60. O(.t) d/ Address
By VM rA ij G 6v Address
nn n CONTRACfOA, AGEN7
PhoneApproved_
PLOMHING MSPEQTO
T1JRL$—� MI31: WIN—DRAIN
UNITS I Fr:Es II IuNITsI FEES
Water Hester I ( I /Ov II Size 14 1
ater Closets I 9 Material
Bath Tub:, j To Curh
Showers I p p II To Prop. Line
Lavatories &v �� To Existin
Kitchen Sinks j on
'Dish Washers / (&V �� OEWFR BOXFO
'Waste Disposals
Wash Trays T STORM DRAINAGE
Washing Machines I f I&,u V Size
Water Softeners Material
Bar Sinks II To Main Drain
Comb. Sink &Trays I F To Curb
Dental Un
g its
'DrinkinFountains
Floor Drains WATER SYSTEM
-Hoppers Size
Restaurant Sinks Matenal
Sand Traps �I TOT L FEES
Urinals Fixture
Area Drains Main Drain Fee
Water Leaders Storm Drain Pee
Sprinkler Valves I Water Sys. Fee I /0-0
Permit Fee lov
TOTAL I
_17 II TOTAL FEE
RECORD OF,4NWCTION
',Partial Rough r _
Rough Complete, _
'Final
Cupertino Sanitary
(jkficc,copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No.
.......................
ePlumbing Final Plumbing Permit No-
Lot No- ------ ..................
Owneror Tenant.... . ........ .......... ..... .................... --------------------
................................ ............................
At ... .............
Tract ... ................... ......... ......................
Date Connected ...............................
...................... .. ...... ......... -------
DateFinal ...........................................
UMHING INSPECTOR
tit 1160-500