1422• // /� I ��/�/- iCl4 LOT NO.
STREET
- M""-APPLICATIONMFOR-PLUMBING PERMIT
�"'�` ,'� ' ' •� t �-,''a,CITY, OF CUPERTINO
.. rFt6 2 7 y tia ����
Date ^" • 1 5 _ Permit No.
CITY OF CUFTfi�Q;`r
Fee
7
Application is-hereby_made to the Cityof Cupertino.for_a,permit to install plumbing
pipes and/or fixturev listed on the r 6erse side hereof,:and agrees. to install said prices
dnwth,theosf m_gand/or',fixtures imaccorcpviionsoh,Codof the City of
�gg Cupertino, and all other laws applicable'thereto.,
Use of Premises
Owner / ��c� �/ 4� Address.z
By /F 1% 1264 / 4V,?r' Address
�5 NTRACTOR AGENT
7Phone gC�OSO�T. INC- _ Approve
S21 MEPI®IAA! RDt MEING INSPECTO0.
1,_T URES NUMBER
MAIN DRAIN
�'.`>' I UNITS I FEES
UNITS1 FEES
ater9Hedter
Size
titer Posets I
Material -
Bath Tubs
To Curb
ho,cr, '
To Prop. Line
—=
Lavatories �
� To Existing
Kitchen Sinks �
Not Conn.
Dish Washers':'-•
Waste Disposals ;y..- -
Wash TrayEr
STORM DRAINAGE
Washing M!`'chines
Size
Water
Material I
Bar Sinks
To Main Drain
Comb: Sink a Trays I
To Curb
Dental o
Drinking UnitsF.ountainsl �
� ` I
II
Floor Drains
WATER SYSTEM '
Hoppers'
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Ur naIss
jArea Drains I 1
Fixture Fee , '
11 Main Drain Fee
WaterpLeaders 1- 1=
11 Storm Drain Fee, I
S nnkler V,Sives
a "+
Water Sys. Fee
�.'
Permit Fee
TOT L"` �,__
II TOTAL FEE d
RECORD:W INSPECTION
Partial_ Rough _
Rough Complete
Final 113o Z