644......r.s.�••�- O �'�\ � �.w.�. w«... ..�.. _.. .. rr:.w .�i:+�rW�..criz'�nr..sr'�
LOT NO,
NO. STREET '
APPLICATION FOR PLUMBING PERMIT
!/�'n CITY OF CUPERTINO
Date/"� ` "'^ 19�U. ,Permit N .
4 is 1 F t -x 'Wou .5
Fee $
Application is heiebfrffir a Eo tfie City of Cupertino for a permit to install plumbing
pipes hand/oi fi'xtures listed onithereverse side hereof, and agrees to install said prices
V and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other 1��34 applicable thereto.
v
Use of Premises
' Owner `' ` P. / Addre 01 D
By
Address
CONTR O , AENT PO N
Qyp
LUMBING
Approve
Phoy !-z 14
---rl-X-TURES NUMBER j MAIN DRAINZ:,-
UNITS FEES H UNITSaF.EEM
Water Heater j j Size j' y
Wafer Closets j jj Material
Bath Tubs j j jj To Curb
Showers, I {� To Prop. Line
Lavatories j j jj To Existing
Kitchen Sinks j j j Not Conn.
Dish Washers j jl SEWER BOXES
Waste,jDisposal's
waslf--r'at's ' ", j.,. ! j jj STORM DRAINAGE
Washi"rig Mackimes'L4 Size
W—_�" s � • �1 j j Material j j
B Sin �i� To Main.Drain
-o_m�' Sink q Tiaysj jj To Curb
DenntajjUnits
�D?inking�Fountainsj j II "' j
.i,,.' - rN-ins j j j WATER SYSTEM'
H°FR:rs j j jj Size
Restaurant Sinks j j jj Material
Sand Traps j j jj TOTAL FEES-
Urinals Fixture Fee I .y;•
Area Drains j j IFMain Drain Fee j-.'`.
Water Leaders j j jj Storm Drain Fee-j'
Sprinkler Valves Water Sys. Fee j
�Aermit Fee
TOTAL j V jj TOTAL FEE
t
RECORb OF INSPECTION
? Partial Rough
Rough Complete,
. Final .54V&2
r .i+ .dam