684LOT NO. • -
NO: STREET.
APPLICATION FOR PLUMBING PERMIT(•%)`'l •
CITY OF CUPERTINO
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Dat e•• _ 195 Permit No. T'
IMAR ti o 0
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App}� , isF , I, mad4e3t Waity of Cupertino for a permit to install plumbing
pipes 'I, fi�itures AMfid on�he reverse side hereof, and agrees to instail•said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and • all other laws p¢plicable thereto.
Use of
;� Owner U : r-' /
UNITS
SEWER
Hoppers - L 11
Size /
Restaurant Sinks I II
Material A L I
Sand Traps
TOTAL FEES
Urinals "�
Fixture Fee I
, —00
Area Drajn4,.-I I II
Main Drain Fee
/
O p
Water Lea�rs I I
Storm Drain Fee
Sprinkle%, zw.
I Water Sys. Fee
•�' I
Permit Fee �.
e7 p
TOTAL I I
TOTAL FEE i 7.00
RECORD OF
,,I SPECTION
PartialSR.ough
Rough Complete j
Final
��,� ,Cupertinv Sanitary
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO'
Sewer Connection Sanitary Permit No: ---- .eJ.S�'.
..........
[#/Plumbing, FinalPlumbing Permit No...... 0_1..... ......
Lot No`6;----- --------
Owner orr/Tenant
pp....
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fl At---../.y..�..�'.
Tract ..........
Date Conn
i ''.Date Final
.............--------//- -
�
............. 19--66
ZA
...........---..........I----:------.---........ 19.
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P .JMBING INSPECTOR