1769 a / i .. L4 i ��A Z.ei L -� LOT NO.
`
S NO.�' V ASTREET ,
f A i4T1ON FOR .PLUMBING PERMIT
t � T-J CITY OFF CUPERTINO �j•
Date �AUG 3 U ' I 194'_l'° Permit No. ', f
r CITY ` ('�IPERTIf O Fee
0• O C)
�. Application is hereby made to the City of Cupertino for a permit to install plumbing
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,
Owner `�' Address 4�a__ l� F`
By Address c!/
CONTRACTOR, AGENT i r
Phone/J/✓? —3 F77 _ Approve
r PLnMBING INSPECTOR `` )
1 I
FIXTURES NUMBER MAIN DRAIN
UNITS FEES IUNITS FEES
Water Heater / Size 1
Water Closets Material e—r I
Bath Tubs / ( To Curb I `
Showers - / To Prop. Line
Lavatories To Existing
Kitchen Sinks N on J
Dish Washers I 'SEwEe somas 3-dts
Waste Disposals _
Wash Trays STORM DRAINAGE
Washing Machines / Size
Water Softeners J Material
Bar SinksTo Main Drain .
Comb. Sink a Trays I .To Curb j
Dental Units -
Drinking.Fountainsl I
, Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material C— .t
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Tee
Sprinkler Vawes Water Sys. Fee J.. Iy r)
,Permit Fee or)
TOTAL TOTAL FEE
. (yp>fCCIRD oFLjdjyjCTION
Partial Rough
Rough Complete �..,
Final _✓�
- - Bldg:Dept.
• - '` Office Copy
BUILDING INSPECtOR'S OFFICE
CITY OF CUPERTINO ry //
Sewer Connection Sanitary Permit No. ...... �..::-------
.. .._. ? p
-
G]/Plumbing Final Pltttnbing Permit No. .1/Srte/O'/ -
Lot NO. ----a/ .
Owner or Tenant ------.
a33-
Tract ......-----'-'-
---... - ......... -- --_ ................ ...............
Date Connected -...---....---..
----- ----120: � -----._..--- ---
19. .. ..
Date Final 4-t7 ..................... _
a
PLUMBING ,INSPECTOR S,
111 7/61-500 '