653 0.7D( I /CN� LOT NO.
NO. STREET
�q APPLICATION`FOR PLUMBING PERMIT �f �o
Min, � OF CUPERTINO
U Date — 95_ Permit No.
Fees _
Apel,,Y,ioV'htttjP7'¢(t!(e�City of Cupertino for a permit to install plumbing
pipeYs�rjandt/or xtures liste on iee reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
8 Use of Premises—
Ow ner ` S S Address 0 76, lO
By A/ZAddress ✓may +tfl�o�1�L
co ACTOR, AGENT
Phone _ e? Approve
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN -
UNITS I FEES UNITS FEES
Size
Water ClHeater
Water osets j Material
'Bath Tubs j j To Curb j
Showers To Prop. Line
Lavatories To Existing
DjK ch Sinks
ish _ j Not Conn.
Washers SEWER BOXES
ante Disposals j
Wash Trays STORM DRARNAGE
'Washing_Machines I Size
Water Softeners j Material
Bar Sinks j j To Main Drain.1 I
CombTS a j To Curb
Dent l_jg F s
Drinking Fountains) j �I
Floor Drains WATER SYSTEM
Hoppers Ij Size.-.,. .
Restaurant Sinks j ,j,:.MsiferiHt
Sand Traps j —' T,OTA,LS�FEES
Urinals j j F.izture'_F.eej. •.y
Area Drains j j ';;ji;.:Main`;Drai'n`,FeeR ', %;OCA
Water LeadersStorm^L)�airi.Fee` " -;1�
I I If
Sprinkler Varves j Water.SYSr,Fee
Permit Fee •D
TOTAL j jI .TOTAL FEE y,asT-
RECORD OF INSPECTION
Partial Rough
Rough Complete f
Final