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1549 /D/9 fr �'62TA L u-. NO. /Sf NO. STREET, ® ` P Ike NJOR PLUIdIBING PERMIT,', TX OF CUPERTINO MRY 1 � 61r Date 19�� Permit No. CITY OF CUPERTIN© Fee 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 and/or fixtures in accordance with the provisions of the Plumbing.�Code of the,City of Cupertino, and all other laws applicable thereto. a Use of Premises �l f/OE�n/G Lr Owner ? UcTi J.✓ Address' By �UROY Addiess CONTRACTOR, AGENT Phone .�7�— /// _ + Approve PLUMBING INSPEWOF —SURES NUMBER MAIN DRAIN I UNITS I FEES 11 UNITs1 FEES I�Water Heater Size Water Closets I _ Material (, Bath Tubs I / I .To Curb Showers / I II To Prop. Line,A I Lavatories I I To Existing Kitchen Sinks Dish Washers Waste Disposals I I Wash Trays / STORM DRAINAGE Washing Machines Size Wat,r.Softeners Material Bar Sinks To Main Drain Comb. Sink s,Trays To Curb Dental Units Drinking.Fountains 11 Floor Drains WATER SYSTEM Hoppers I Size ?/V Restaurant Sinks I Material 6AL✓ Sand Traps I I I TOTAL FEES Urinals' I I Fixture Fee I ,O U AIC$ Drains I' I Main Drain Fee /, 00 Water Leaders I II Storm Drain Fee Sprinkler Vaives II Water Sy'- Fee 00 I Permit Fee o u TOTAL I /y,Odl TOTAL FEE /•L 0 RECORD OF SPECTION Partial Rough�,3' 3 ` Rough C p ete Final 1 �/ Cupertino Sanitary - ' Office Copy I BUILDING` INSPECTOVS��OFFICE. CITY OF CUP[RTINO ,Sewer Connection _ .Sanitary Permit No'-..-----..- .1....... [;;�Iumbing Final Plumbing Permit No.`.-_� . ......... Lot o - .� t' No. - - Owner or Tenant .... . ..... - -- -' r^ r� +.-- Tract , . ..�'�.� ---------------------------------------- Date ---------- -----------Date Connected ----------- ---------------------------------------------` J la3 ...--:..---..--.. Date Final -......._-. ------------------------- ---._... ----------- 19 _ Z! PLUMBING INSPECTOR . 1t1 1160-500 - -