1370 o�o S3 / 1 1 ie LI` l/ Q ,
LOT NO,
NO. STREET
\� 2 I TION FOR PLUMBING PERMIT •
3� CITY OF CUPERTINO
j
t�VOV 10196I D -2
195_ Permit No.
CITY QF . CUPERTINO Fee $
f1S„ pp 'cation is hereby`Ihade to the City of Cupertino for a permit to install plumbing
pe ndfigures listed on the reverse side hereof, and agrees to-install said prices
and/orifixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all,other la"H' , ble thereto.
Use of Preuvse ''
Owner p t a ✓ 7 2 2 Address
111!>>> Vtlp ByAddress
Phon O Approv
PLUMBING INSPEC R
PIX�lJRES NUMBER MAIN DRAIN
UNITS FEES IUNITSI FEES
Water Heater Size ✓
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks
Dish Washers o ��
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines l Size
Water Softeners Material
Bar,ySinks To Main Drain
Comb. Sink a Traysl To Curb
Dental Units
Drinking Fountains) l
Floor Drains I WATER SYSTEM
H-Oppersi 1 ll Size .l �.
Restaurant Sinks Material--j. .. _
Sand Traps l l ll TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Feel r W
Water Leaders Storm Drain Fee
Sprinkler Valves I II WatC[ Sys. Fee
Permit Fee
TOTAL TOTAL PEE
RECORD OF INSPECTION
Partial Rou h
Rough Con ete
Final /j
UAWe<V // iC 6�... __.
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
10�4p
Sewer Connection Sanitary Permit No- ----4?eQ!(i7v...........
Gao-Flumbing Final Plumbing Permit No. -/6-27,0Lot No. ........................----
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Owner or Tenant ...
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�-5At ..... PVL - - --
Tract --------------------------------
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Date Connected .......................
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.-,Date Final ------------ -----------
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PLUMBING
111 7/61-50o