2128 LOT NO.: ..
NO. STRETjjW
® "Wal OO FOR PLUMBING PERMIT
V f , OF CUPERTINO
Q
Date 19pz_3 Permit No.
CITY OF CU ERTIN0 Feer$_
-:Application is hereby made to the City of Cupei lino, ra peerr�mit to install plumbing
,;pipes and/or fixtures listed on the".reverse side hereof, and agrees to install said prices
O ,,and/or,fixtures in;accordance with the provisions ofathe Plumbing_Code of the City;of
Cupertino;•and all 'other laws applicable thereto.
gg v
8 Use of Premises
Owner4 • ' 1^,--0,-0 h Address ��_
o c i'.
j _ � 'a ' _ Address G .,
t .C�®CTOR. AGE pp
` 1 A d
Phone rovePLU BING INSPECTOR
F13TURES NUMBER MAIN DRAIN.&
_ I UNITS I FEES II (UNITS 'FCES
Wacer Heater Sae
Water Closets Material
Bath Tubs To Curb �• pp
Showers To Prop. Line I Y }
Lavatories - �� To Existing -., I
Kitchen Si _ I� Not Conn. v
.Dish Wasliers
Waste Disposals..-�,
� aslr-Trays . j; - II STORM DRAINAGE'u.
Wfteners Size _ 1 '
e
Material
Bar Sinks To Main Drain
Comb"Sink'& Trays To Curb
/Dental Units
'Di'inki'ng Fountains II
Floor Drains I WATER SYSTEM
Hoppers Size
Restaurant Sinks _ �� Material
Sand Traps TOTAL FEES
Urinals Fixture Fee,
'Area Drains _ Main Drain Fee
Water Leaders Storm Drain Fee
Spdmklcr Valves Water Sys. Fee ,
Permit Fee
TOTAL 11 TOTAL FEE .Q
RECORD OF INSPECTION ;�•
Partial Rough f
Rough Co I,et
Final
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