928 /D.V �F I 4 a F- J J'O DJQ NO.
NO. ZEA '^�
nI ,;FOR PLUMBING PERMITIff �� '•
OCT 4
1V t +OF CUPERTINO
Date l c t 4095b v Permit No. qQ
V Fee $ �J
Application is hereby made to 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
lb and/or fixtures in accordance with the provisions of the Plumbing.Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises—5f/ Al G ' -. A/ c L
'a
9 owner GC--O CIV Address
I
By S 144 1 J 1%)A1 B/1YC V Addr r IA Cr
N
�= COCfOR, AGENT
�o_S-- Phone �� ' -/q� APP PLUMBING INSP
FI ORENUMBER I DRAIN
UNITS I FEES UNITS FEES
Water Heater I Size
Water Cosets Material
Bath TuUj To Curb
Showers , To Prop. Line
vLavatories' To Existing
Kitchen Sinks I Noo
Dish Washers E oK
Waste Disposals I
W' ,sh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink &Trays , To Curb
Dental Uniis
Drinking Fpunminsi � �I
Floor Drains �� WATER SYSTEM
Hoppers —T SMize
Restaurant Sinks aterial
Sand Traps TOTAEES
Uoinals �� Fixture Pee ,2
Area Drains Main Drain Fee / pa
Water Leaders Storm Drain Fee
Sprinkler Varves I I I Water Sys. Fee I &M
Permit Fee -C70TOTAL TOTAL FEE I y ;i,5,
RECO D OP CTION
Partial Rougll
Rough Cr�plete
Cupertino Sanitary
=ti Jffire Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Fj Sewer Connection Sanitary Permit No. ................................
dumbing Final Plumbing Permit No. �
............
Lot No. ..a...................
Owner or Tenant ...... ............................
•
At ....... . ....
.................................................
Tract ................
Date Connected ...........................
Date Final ................................... ...........................
...............................................................
);501-5------ - ---- ...................................
MBI-N�G�INSPr�CTOR
Ill 1160500