1577o �I A
l \Q IX T No. A2
( NO. STREET -
p.IOR PLUMBING PERMIT
CI LpI CUPERTINO
JUN s m2 IJ Y
Date 195_ Permit No._
CITY OF CUPERTINO Fee s �2 7
Application-is hereby made to the City of Cupertino for a permit to install plumbing
pipes an 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.
L . Use. of Premises
:a
14
=0wnera/"AGEN
.By _ .Address • �6+< yeGeU
i ' = 4. one ApprovedrQPLUMBING INSP o
D�inkin�, Fount3ips�
� �I
�
�_
Floor Drains
WATER SYSTEM
Hoppers
Size `
Restaurant Sinks
��
Material '•'�
Sand TrapsI
TOTAL FEES
� Urinals �
�
�� Fixture Fee
'Area Drains
�� Main Drain Fee /
e.
Water Leaders
�� Storm Drain,Fee--�T—
Sp ki Vaives
'S -
TOTAL _
'�
124 sc
11 Water Sys. Fee -- /
11 Fermll Fee I I. /
11 TOTAL FEE„- - , 7
�
j
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S ,OFFICE ,
CITY ,QF CIJURTINO
9-<er Connection 4- �j.-
Sanitary Permit No..:I �C... .77...-.
0r'Plimibing Final Plumbing Permit No. ......
(._<l'.�
Lot No. .... U.........
Owner or Tenant.\....'....._s.:_-.......r-q........ ....... �
r
,.. -
Tract.............. ........._...
Date Connected ...............................
--^-- O� ..............C&-
-- -- ......_9..^
.._----........�_ ..._---...------....
t
Date Final .... :... ..........
19
PLUMBING' INSP O
111 7/61-500