1181 / V' / / ti_ / .•"' LOT NO.
NO. S
ET'
°• �i
APPLI ATION *F R PLUMBING PER T
CITY;- OF CUPERTINO &
Date J 19 Permit No.
a �o
i :x . .,l1PERTINd . Fee $ 4E �
'•'`
is APPllcation is hereby made to the City of Cupertino fora permit to install plumbing
i pipes and/or fixtures listed on the 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.
Use of Premises
N Owner' Address
" y� Addt
•CONTRACTOR, AGBNT
'� ( Phone Approv
P BING INSPECTOR
t
e TURES NUM$ER t4f -IN DRAIN
UNITS I FEES- 11 A�,Ij ' .UNITS[ FEES
'Water Heater Size
Water Closets 1 Matenal(��,:j'�;
Bgth Tubs j j To Curb
Showers To Prop. Line _,=.r.
Lavatories i� j To Existing'
Kitchen Sinks �"' No Con /J /
Dish Washers
Was Disposals
Wash 1.raV STORM DRAINAGE
Washing Tachines Size
Wate4 So„teners j j �j Material
Bar,..Sinks j To Main Drain _
C br Sink&Trays) j To Curb
Dental Units”
Drinking Fountains)
Floor Drains WATERS STEM
Hoppers Size j
Restaurant Sinks Material�jgL, j
Sand Traps TOTAL FEES
Urinals Fixture Fee j Q
Area Drains j Main Drain Fee
Water Leaders Storm Drain Fee j
Sprinkler Vaives j Water Sys. Fee . Q CJ
BEWER BOXES j Permit Fee j
r TOTAL j TOTAL FEE
RECO D PECTION
Partial Rough
'hough Complete
Final
I, the undersigned do hereby certify t tit I am ?,
s,t
I the owner and cuppnt of the single family dviell.ing at
JILaw's?
ZazLafor':UihI h I am makiri
application to d c:' .
PP cork . s a:$i�me'ot,*ricr.
1,-,141 certify that I will not hire, any�non-licensgd
•q , a
or contractor, but H`_ o this Mork� myself. '
TELEPHONE YUPI.B R SIGNATURE
\• � � Bldg:Dept.
.Office Copy
BUILDING INSPECTOR'S IOFFI`CE'. ,?k-
CITY OF CUPERTINO 600401
[] Sewer Connection Sanitary Permit No. .- � ,! '•`N~,
. _ . .�i:.
Ed,,Flurnbing Final Plurnbin Per'mit3'dr ory,'�,+�°
V
Lot No. ..__........
Owner or Tenant
---------------
. . ....... ^
At .--,..,-Q7�--- - �? ti
<
Tract .. —
JC.�' _.
Date Connected .......................... ..... - . . .....
. ..............
. .....
Date Final --...............................-`--=/. ._- - -- - ----- 19. 3-
L'U
PLUMBING INSPECTOR
111 7/61-500 ._r.�..._. -