509 OI 1 � 1A LOT NO.
NO. STREET
H'
APPLICATION FOR PLUMBING PERMIT (Sri
CITY OF CUPERTINO
Date_ � 195_ Permit No.
��Iae
Tfie
A JicaAOCIS �eb City of •u "r�ti�o�� or a permit to install plumbing
pipes
and/or fixtures listed on the'rev tse ss2e hP"reof",%Ind agrees,to install said prices
and/or fixtures in ac qqy�an�g pio%unn4zoE the Plumbing�Code of the City of
Cupetfll}3; and(allloh§ tt' blelthereto.
Use of Premises _
y C
Owner •49 Address
B C dml�_ Address
CON ACTOR, AGENT
Phone Approved
G—; PLUMBING INSPECTOR
FIX S__F NUMBER 11 MAIN DRAIN
I UNITS I FEES II IUNITSI FEES
Water Heater Size 6
Water Closets rel 11 Material Cl l I
Bath TubsJ" To Curb
�IShowers f �� To Prop. Line ' �!
;Lavatories II To Existing
Kitchen Sinks Not(COO
Dish Washers .
t Waste Disposals
Wash,Trays II STORM DRAINAGE
Washing Machines Size
Water Softeners Material I,
Bar,Sinks .l To Main Drain �.
Comb. Sink & Traysl To Curb
-Dental Units
Drinking Fountainsl II
�JFloor Drains WATER SYSTEM
iHoppersI ILsize
Restaurant Sinks I II Material• l
!Sand Traps TO A FEES
"Urinals Fixture Fee r 0
i Area Drains Main Draih Fee
Water Leaders l Storm Drain Fee /
Sprinkler Vaives l l ll Water Sys. Fee•
Permit Fee �•n �)
TOTAL // l //.0011 TOTAL pEE,
R COD O I SPECTION
Partial Rough a —
Rough Complete �
Fin,
., .. 'Cupertino Sanitary, ,
. Office Copy,
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection
❑ Sanitary Permit No. ......................... ......
x`Plumbing Final ' - - Plumbing Permit No. p
...
Lot N.
Owner or.Tenant .... .....- `_ � _Q -
A �
At
Tract ...lS• .---- --------.//
'- ---rr `. .
Date Connected ......a". ta,. //..- ...;(.'.: -- --- .. ... 19..........
Date Final ............��T--------- -..... ..'.:. '
-
P1. 131";G INSPECTOL, �_.a. �..:.
111 1160-500 -