839 ���// _ 5
!/l/VY LOT NO. /l:1 � .
APPLICA,TION FOR PLUMBING PERMIT 0-5
CITY OF CUPERTINO
-M te I�✓L,s� L�� 19& Permit No.
�o
Fee $
Application is lereby made'to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side helrof;,and agrees to install said prices
and/or fixtures in accordance with the provisions.of'the.Plumbing.Code of the City of
?'r:•• Cupertino, and all other laws applicable thereto iF
., Use of Premises
'a" i
Owner �'✓_�._,. / /rvrAddress/D40
` y
By 7�iinn- /: ; Address os 5 yo
'i'.:iCONTRACI0R, AGENT
if _Phone Y'G`r��� Approved
.+ ULIBING INSPECTOR
---f_IXTURES—_7 NUMBER .,MA1N-,L)KXI—N
UNITS I FEES I UNITS I FEES
Water He,Reew.A: kjzl!s ii
Water Closets -Material
7
Cur
_,To T
ath b
'Showers 05' 11%j 1111; Tp' Pr6p:,"Linq
Existing
Kifchen 6-iffiBj V I (1,m 11 F, I_NotcCoo
p Idw
Dish WashErs'! 1# '1",: 11 SEWER BOXES/
Waste—Disposals
Wash Trays " :41 11 11 STORM DRAINAGE
WashinglMachines Size
Water Softeners I Material
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains)
Floor—Drams WATER SYSTEM
jqoppers I Size
.,Restaurant Sinks I I I Material
Sand—Traps I 1 11 TOTAL FEES
Urinals I I Fixture Fee
Area Drains Main Drain F
Water Leaders I I Storm Drain Fee
Sprinkler I I II Water Sys. Fee,"
Permit Fee
TOTAL TOTAL FEE 9-:—
RECORD OF I PECTION
Partial Rough 7 "
Rough Complete
11
Fina
- Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
III CITY OF CUPERTINO
w�rryy
M. Sewer Connect{ori Samtarg P.ermit No: -;/✓7L.�. :.. .
III .99"Plumbing Final Plumbing Permit No. .. q'�- •`�
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,.Lot No.,..
Owner or Tenant . . /' - - -- - i(.C� •_ hl r.
.� '
-... .
Tract t'u"""
Date Connected . ..... -_`- = 19�
Date Final /L - ..,.,... ............... ' -`--- '
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[?LUMBKG INSPECTOR
i i t l/6o_500 . . `,_f