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APPLICATION 't OR PLUMBING ;PERMIT w
r tr } i CITY OF CUPERTINO
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Date t95_ Permit No.
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,
Fee $
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'A is atio Fis i Sr�by�madglto 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.
??tt Cupeitino, and' all other, ws applicable thereto.
uUse of Premise '
Owner�J(JilJ�S�i / Address
BY l _ Address
// CONTRACTOR, AGENT 0
Phone�'Yl- 3--e ZZ Approved
AMBING INSPECTOR '-1/
iN11N_ 1 f I I 1 1
['MURES NUMBER MAIN DRAIN
UNITS FEES If IUNITSI FEES
Water Heater Sae
Zt
Water,Closets i z I Material r
Bath -rubs _ I To Curb
Shower; l I To Prop. Line
Lavatories II To Existing h
Kitchen Sinks / I-7m,conn.
Dish Washers I II SEWER BOXES
Waste Disposals II t.- I
Wash Trays II STORM DRAINAGE
Washing Machines / Size ' I I
Water Softeners Material
Bar Sinks To Main Drain
Co_ SinksTrays To Curb
en - Units —
Drinking Fountains) II
Floor Drams WATER SYSTEM
Hoppers I' I Size I_
Restaurant Sinks Materi gL
Sand Traps I I TOTAL FEES
Urinals I I Fixture Fee !2,00
Area Drains _. I Main Drain Fee I j O a
�X'ater Leaders _I I Storm Drain Fee
Sprinkler VarvesI I I Water Sys. Fee
. I I Permit Fee Imo/ QQ
TOTAL TOTAL FEE / ? 00
RECORD OFJI SPECTION
Partial..R
ugh'Lompletf TZ-
cilia!al'•:' _�
'Gupertsd�'S7$n�lna
+�0' • 't'i^ Office COPryY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit ,No.y:._.jCxp...J'............ '-
[j]/Plumbing Final " i Plumbing Permit''`No. ....fji.12. ........
jJ Lot No. .... ..�
Owner or Tenant ....._.. / .. ......__.. .. ..G'�... ............ r-_.._....
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......... .....��J- ...........................................
Tract ------------------t-l� .. .. .......
' .:.. ..........""-----"-"----"---- w
Date Connected -------------- -40.0......- - -:...---
...---
..- - .. 19..
,
..................
Date Final ..... .......... -
- .. - -G._..._.._....... . .. ............_......_..................
_.. ..............................
111 7/59-500
.UMBING, INSPECTOR