1780 LOT NO,
NO. STREET
�P[t U
FOR-•PLUMBING PERMIT
� I1 OF CUPERTINO
( �,
IDa ' '�, 1` 19G/�?� Permit No. / (�
CITY OF CUPERTINO Fee $
Application is hereby made to the City of Cupert' o foy 2r\i ra�Istall plumbing
pipes and/or fixtures listed on the reverse sideo , `agrees 'S41-said prices
^J
and/or fixtures in accordance with the provisioQshe Plumbing Co8de of kt'he City of
Cupertino, and all other laws applicable thereto �SEP A- - 1962
Use of Premises
Owner C , D y Addres J°
> B `. Addres
CONTRACTOR, AGENT. l
Phone 5���i31 n - -T
_{ Approve ,
PLUMBING�INSPEC OR
IX CJRES NUMBER MAIN DRAIN
UNITS FEES IUNITS1 FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories I I To Existing
Kitchen Sinks Not Conn.
'Dish Washers SEWER BOXES
Waste.Disposals II
Wash Trays II DRAINAGE
V(/ashin� g Machines I Size STORM
r-Water Softeners Material
Bar Sinks ' To Main Drain
'Comb. Sink s Trays) I To Curb
Dental Units I Drinking Fountains) I I,9
Floor Drams I WATER SYSTEM
Hoppers I I Size I_
Restaurant Sinks I Material
Sand Traps I I TOTAL FEES
Urinals Fixture Fee I ;4
Area Drains I I I Main Draih Fee '
22 Leaders I Storm Drain Fee
d der Vyvw I I Water Sys. Fee
Permit Fee '-
TOTAL TOTAL pEE•;.?.r;:.: .•`'
RECORD OF INSPECTION------------------
Partial Rough
Rough Complete
Final