1522 0I 0ZF C(JC� LOT NO.Z4
NO. STREET
AP T�O: OR PLUMBING PERMIT
11 (,, Cr UPERTINO
Date - � p6Y�ysL 962' J� �•
Permit No.
CITY OF CUPERTINO ' Eee $ ' -
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 ces
-and/or.fixtures in accordance with the provisions of the Plumbing Code of the CI1 of
Cupertino, and all other laws applicable thereto.
Use of Premises
U / 7a7
V Owner 7�%� -fit/ Address
ByAddresso
CONTRACTO AGENT
Phone ES 7--5/v(00 -T Approved
PLUMBING INSPECTOR
FIXTURES NUDiBER MAIN DRAIN
[ UNITS [ FEES [[ UNITS[ FEES
Water Heater Size 4Z/I/
Water Closets Material G'
Bath Tubs To Curb
Showers To Prop, Line
Lavatories To EXisting
Kitchen Sinks .y 4/'1° IN C n.
Dish Washers
Waste Disposals
\X/ash Trays, STORM DRAINAGE
Washing Machines h / °nil Size
Water Softeners Material [
Bar Sinks To Main Drain
Comb. Sink a Trays[ To Curb
Dental Units
Drinking F,ountainsl l ll l _
Floor Drains l WATER SYSTEM
Hoppers Size f .14
Restaurant Sinks Material6w,�%/
Sand Traps l ll TOTAL FEES
Urinals Fixture Fee ay,SO
Area Drains l Main Drain Fee /, 00-
Water Leaders - Storm Drain Fee
Sprinkler Valves I II Water $y5. Fee X00
_SEWER BOXES Permit Fee
TOTAL AL F E oW .S
Partial Rough 1 ,
Rough Complet j
Final Z ,
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO - 4
Connectiori Sanitary Permit No. ..V�. _�
Sewer m _
. ; Inmbing Final PI ing Permit No. -.-----jw.Y"+�
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Owner or Tenant ------------ ----
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Date Connected ----------------------------- ---_. t9.Z.:..
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Date Final .---------------------------.......-----1� -a•3 !Z_
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19
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PLUMBING,. INSPE
III 7/61-500 '
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