2032 L / s
.x, 5. IO W •, LOT NO. (
NO. 1 .STREET .
APPLICi4 ION FORD UMBING PERMIT
CITY OF�iJPERTINO
=ji:if••�i41F1 K�9���.j� .ti y •'
Date'-'•4"- Permit No. c:>?/ 3L 7� '
Fee $ O c
Application is hereby made to the City of Cupertinofora permit,to install plumbing
�- pipes and/oi-'fixtures listed on the reverse side hereof, and agrees to install said prices
�y and/orfixtures in accordance with the provisions of the Plumbing.Code of the City of
lw 'Cupertino, and all other'laws applicable thereto:
Use of Premises ' ~A 'f't
EA
i ,., .
y Owner �S S�-A c—f Address �L EL,:) I L�
By (., )IC„ I �— �a:ve-ni Address
coNTRwcroR, wcetar
Phone C 1L O�Oe� Approv
LUMBING INSPECTOR
—MIXTURES NUMBER - MAIN DRAIN
I UNITS FEES IUNITS I FEES
,Water Heater•. _ / I) Size �.
lWater Closets- I �• Material Gf
Bath Tubs / To Curb
Showers / To Prop. Line %<
Lavatories „� To Lxi
'Kitchen Sinks ' / .. 11 Not nn.
_Dish WasheYsI I ' II Sewell
aWaste Disposals ' .
'Wash Trays I STORM DRAINAGE
Washing Machines Size
!Water S9criers Material
S' To Main Drain
^ w k a Trays I I To or
at _ is
'D. king Fo mains
Flaar Drains WATER SYSTEM
Hoppers Size I �,
Restaurant Sinks Material epel
Sand Traps I TOTAL FEES
Urinals Fixture Fee
Area.Drains I Main Drain Fee G7
Water Leaders II Storm Drain Fee
Sprinkler Valves I I II Water Sys. Fee
tI I Permit Fee
TOTALIU 1 11 TOTAL FEE
RECORD. OF I N
Partial Rough –
Rough Compl
Final y'
'�'�=� �•' Bldg. Dept.
Office Copy
BUILDING INSPECT \S OFFICE
CITY OF CUPERTINO k;'
Sewer Connection Sanitary Per mit;No:s-=-=-----------------------........
y:•n.4..e;r;�
❑ Plumbing Final ,Plumbing Permit`No...;.--.-.. 3.v.---..
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Owner or Tenant
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At .......... -
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Tract ----...-...---'----....---....-.
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Date Connected .. --
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Date Final ................. } ----_-.-... 19..:
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PLUMBING INSPEC�Q �I
111 7/61-500