1271 � 9 915 Gly I c 9-_ C 11 .'Q LOT NO.
NO. STREET -
PL FOR PLUMBING PERMIT ._
OF CUPERTINO
VISE7P2196f (o21a�
Da , 19S_ Permit No. � 7 1
f0
CITY_ OF CUPERTINO- Fee� `
pplication-Is hereby made to-the City of Cupertino for a permit d 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 o the City of
Cupertino, and all otherI1'w�s a livable thereto.
Use of Premises W ��wJil2ay
m
f�—a.� M 99 IS-
Own ' A Address
By. '�•, /_: �! Address-
"
CONTRACTOR, AGENT < e /CO; I�(/r/'
✓hone Approv
PLUMBING INSP
T—IX-T-URES NUMBER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heater Size
Water Closets � , Material
Bath Tubs To Curb
Showcrst4�, To Prop. Line
Lavatories To Exrg �.
Kitchen Sinks �� N Co
Dish Washers l
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines l Size . 1 . {
Water.Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Traysl l ll To Curb
Dcntal;Units I i
Drinking.Fountains
Floor Drains �� WATER SYSTEM
Hoppers l ll Size l_
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals _ Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
S kler Vai •sWater Sys. Fee
2 J Permit Fce —
TOTAL TOTAL FEE
R COD ECTION
Partial,Rough Q
Rough,Complete
Cupertino Sanitary -
- .._Office Copy
BUILDING INSPECTOR'S` OFFICE
CITY OF CUPFRTINO �j p
Sewer Connection Sanitary Permit No. _p(:��.C.3c-
Er�Plumbing Final Plumbing Permit_No.
Lot No. ......
._:...
Owner or Tenant ._ .
At -----
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Tract —`�'�•
DateConnected --- - .... . ........----------- --------- ---------- ------------
Q
Date Final
'......:...� ....
u.0 MBING INSPECTOR _
,111 1/60-500