1264 I crci . 1`r'c a� �2ce LI,tiL LOT NO. I C
NO. STREET ^ .
2 ICS QRPLUMBING PERMIT-
VS
Date �[2���� , 5_ Permit No. I z61 I (L-
CITY OF CUPERTINO Pee $
-� 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
v_'� 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 t r �" I A J
OwneiK'��Cy r70M� � Address Off)/—
LN
ff)c: LS Address OQ I .
CONTRACTOR, AGENT i
hone L- k CQ—O�O Approve
PLUMBING INSPEC OR
FjxT—uRrS---TNlJNIBER. ,jj MAIN DRAIN
UNITS I FEES 11 IUNITS I•FEES
Water Heater 'II Sae 17 14.
Water Closets �. I It II Material _ Ile—T I
Bath Tubs I / I j II To Curbs f I
• Showers,, / 1 II To Prop. Line `I
-
Lavatories 1 :To l Existing
Kitchen Sinks , . ( SII' No oP �Q ��l/
Dish Washers
Waste Disposals / I' ':•;41, :�) .; ; '
Wash Trays I •'.. ISTORM-DRAINAGE
Washing Machines
Water Softeners 'I I I Mateiidl
Bar Sinks I I .To Mal❑ Drain I
Comb. Sink &Trays JiTo Curb '
Dental Units I I II - } I_
Drinking Fountains II„ . 1 -,
Floor Drains I :WA'TER SYSTEM �\
Hoppers I 'Sitie
Restaurant Sinks '. Material
Sand Traps I ( IIS= 'i} .'T TAL FEES
Urinals I I:'Fizfurel Fee 11,
Area Drains I ',II. Main Drain FeeSI /
Water Leaders 'II � Storm Drain Fee
Sprinkler Valves I I Water ;Sys.'Fee—OTj
WER BOXES ° II^"Permit,Fee -1 j
TOTAL 3 a ;NOTAL FEE
RE RD OF I T N
Partial R%;ugh ] • •" 'I€
Rough Complete
Finals •� /�. r _
i
.. [ .,CupertinoSanitary
- y _ CoPY
BUILDING INSPECTOR'S OFFICE +"
CITY'OF CUPERTINO
_.. 7
Sewer Connection '
�, ,.. Sanitary Permit ��
No� . ---:..- -_ ...
Plumbing Final -Plumbing Permi�No. . .
.......�2.7.�...'..-
-
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Owner or Tenant .....:_t ./.-.�Vlf":P.0 -.
.. � .. ..-- -
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"Tract ::........::.....a��/lr.�r22�?:?'k�f+. ....--_.-_..:-_..::-. c-.:.-<s_- _...-._........
Date Connected ..................... / / .
Date°Final ------ �' _...-..._--..._......................_--:.. 1rX.
i
j /_PLUMBING INSPECTOR
1/CO-500
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