1672 /Oo26/ f aRTd� /�l�riyyr Lnr NO.
NO.
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R -PLUMBING PERMIT
3 Z
1962CI� CUPERTINO
. Date CITY
� - N�.Z Permit No. f 67 1/
Fee $ /��,y d
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
�i and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
V Cupertino, and all other laws applicable thereto: t
Use of Premises
U fib"
v
Owner T/-)oMAt GcwstRoarie�• Address L
By_At,.OW K .0111 — Address
CONTRACTOR, AGENT
Phone .Paf—f/// Approved
1 PLUMBI INSPEC R
FIXTURES NUMBER 11 MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater I / Size !/t/
,.Water Closets S I I Material G/
Bath Tubs { / To Curb
Showers / I To Prop. Line
Lavatories {/ I To Existing
Kitchen Sinks / I Not Conn.
Dish Washers /
Waste Disposals
'Wash Trays / I I STORM DRAINAGE
WaMachines i Size
Water Softeners I I _ Material
Bar Sinks To Main Drain
Comb.Sink &Traysl II To Curb
G'ental Units I _
Drinking Fountains , II
Floor Drain; I WATER SYSTEM
i Hoppers If Size y I_
Restaurant Sinks I Material GA,ty, I .
Sand Traps I I I TOTAL FEES
Urinals I I Fixture Fee I—` 00
Area'Drains Main Drain Fee ',� 0 p
Water Leaders I II Storm Drain Fee
Sprinkler ValvesI I II Water Sys. Fee I I- 00
Permit Fee I ,Z,u p
TOTAL I - I TOTAL FEE /7.0 p
RECORD OF INSPECTION
Partial Rough e.� R rl_(1 �. 7'j1 n F" ^1
Rough Complete �,I wk rl 1'1_ 1::, 'd 11 P 1" 1
Final '.1 .. ;1 '_i
i