1457 OO I Ay 'I ' C.'�C�� �'\ LL L �•U 'LOT NO. u
NO. STREET '
® FOR PLUMBING PERMIT
I F CUPERTINO .
/MAR - �g
Date — Permit No. S 7
CITY QFC�P RT�N(� Fee $ 5 • o
Application is herebyma&e to'thb`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.
8 Use of Premises / A
n Ownet � IPLL�I Itr�MLS Addre+§ ''7b ,YQ11J
gy Lc7fT .S o tJ C�
Address / O0 l 0 tz
�,/�� CONTMCTOR, AGENT
Approved —
PLUMBING INSPECTOR
FQ JRES NUMBER 11 MAIN DRAIN
1 UNITS I FEES 11 1 UNITS I FEES
Water Heater / 11 Size I �'
.Water Closets Material �G
Bath Tubs To Curb
Showers To Prop. Line
X
Lavatories ToEx ing
Kitchen Sinks .� / No Conn
Dish Washers _
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines / Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Traysl To Curb
Dental Units I �.�
yDtioking Fountains
Floor Drains WATER SYSTEM
Hoppers Size �—
Restaurant Sinks Material A��J
Sand Traps TOTAL FEES
Urinals Fixture Fee _ 102.-�;o
Area Drains Main Drain Fee j .O
Water Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee ,1 00
�i5\/ `a • aw I Permit Fee y . 60
TOTAL ':l , O I� TOTAL FEE Cp
CO D OF r TION
Partial Rough
Rough Complet 9 z
Final (z
1.
CnpecnnoSamtacy -
:$`. • .�.., r. '� .Office Copy
BUILDING''INSPEC,TOR'S;.OFFICE
CITY OF CUPERTINO
' • • n SewePl-`Connectton Sanitary,Peumt No
-----------------
s'&}/Pdumbing Final Plumbitig Permit'No . `7 o f - ,
Lot.No • �ll
G -
� ~Owner or.Tenant � U '
- Tract - ..
Date Connected -------------- L)�z .
Date I'mal -----
f o - 19
'z.
� -- ---
M1lINC INSPECTOR
__-_. ,1 tt 110-500. _ .