1213 LOT NO.
NO. STREET
.I T FOR PLUMBING PERMIT• .. • . i.
�t SEP 12 �9U1. OF CUPERTINO
n.
Date 195_.- Permit No.
/ •
CITY OF CUPERTINO Fee $ 19
Application is hereby made to the City of.Gupertino 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
VCupertino, and all other laws applicable thereto.
Use of Premises 161r/'0rivar
a, 1
� Owner r Address foie rotr� i. ,
By / vet /o. Address
CONTRACTOR, AGENT
Phone FSR- -Fiji d. Approved'r= n'.i..�.
PLUMINV
ECT INECTOR
'y
FIX IMES NUMBER 'r .,M_ AIN • RAIN•f',
UNITS I 'FEes II luxitsl FEES
Water Heater i Y jj. Site "t�Iv Y-•.� H'/
Water Closets
Bath Tubs 1' , ;. jI Td Cdrb4
Showers t,2 ill To Prop. Linep:j
Lavatories To Existing; ,"''�
Kitchen Sinks I . ' _ N C6"
Dish Washers ' I �:.' • Ii SEwE BO cE a 2.5�r0
Waste Disposals :'_, S
Wash Trays STORN%PRAINAGE
Washing Machine' -Size r`
Water Softeners Material ,� n}
Bar Sinks To Main Drain
Comb. Sink a.Traysl I I I'll To Curb
Dentai UnitsL, 1 1 ,, c1-?I_
Drinking.Pountainsl 11 9 ,:.,};;�
Floor Drains WATER-SYSTEM .
Hoppers �. '� .'Size. i t^`tu:1 l "3IN
Restaurant Sinks �� 's4aferialrl�r��t: ,�*6Aw. �
Sand Traps �� %TOTAL"•FEES '
" Urinals I Ij Fixture tF¢i'; t.Y�N�y70o
Area Drains �� , Main Drain;Fee�j';3,;s"o
Water Leaders Storm'Draih'�Fee �?.;r'•tir,
It Sprinkler Vawes I Water
Permit
TOTAL TOTAL F>;E('e U.
RE ORD OF
Partial Rough 3 l y �'•{;; .;,�.,-,':t•.
,Rough Comp,
Finale _ �/ ;.�F:ti' (r'ss` :``I
Fina . h')$
j .'.1 irk';ttt
Cuo Sanitary
ce Copy .
BUILDING 'INSPECTOR'S -OFFICE
II. CITY,OF CUPERTINO v
is �D—
❑ Seiner Connection � Sanitary Permtt'No. ....r�.... �?........ .-. "
[I�-�Plumbing Final - Plumbing Permit.No'�.. /
of No.
V
Owner or Tenant
At m ....�.....<4c. a .
II� Tract —
li.� .
5�!.D�te l l., •i-, .. _ `.' L
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11,1/60-500 M1 +4 ,„y1* �[/`'MHIi\C INSPI CfOR. ` .•.. .