1447 / 171 I Oicr—r R,900, U)e LOTNO.
NO. STREET
D R PLUMBING PERMIT
F CUPERTINO
(MAR 20-196201 '
y Date WW'A( /9 I9KA- Permit No.
CITY OF CUPERTINO Fee $
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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
V Cupertino, and all other laws applicable thereto.
Use of Premises '40i-</e A/L L'
v
Owner fGP!(/2Ti.v� .agopbcT/�C Address GGf'r.7ri�v8
Hy P//R.0 Y p/um Ria AddressL
CONTRACTOR, AGENT ,-
one Approve
PLUMBING INSPE
UR : UM : I DR
UNITS I FEES II 1UNITS 1)FEES
�Wotcr Hentcr �` Size
iWater Crosets -r• I Material , ,,,I
tB'ath Tubs I I I To Curb
1 owess - I I To Prop. Line
Tdvatories ," 1 I To Existing
Kitchen Sinks I I No!Eo 9
Dish Washers
VJ✓ Disposals
\ ,ash Trays j STORM.DRAINAGE'
'Washing Machl�nes I Size
V(�ernt Softeners' I Material
,13ar Sinks :.;,;... To Main Drain I "i
mb. Sink Trays I To Curb
ra I I II I
Dental Units
.D eking Fountains) II r -'a
,Floor brains I WATER SYSTEM
"Hoppers I Size
e
Restaurant Sinks Material
- I I II trALY• I I
•Sand Traps I I TOTAL FEES
Urinals I Fixture Fee
rea-Drains I Main Draih Fee I /. OJ
Water ]readers I I Storm Drain Fee
$p-- kler'Vaives I I I Water Sys. Fee , „J
Permit e
TOTAL,; g II TOTAL�FeFEE
RECORD OF INSPECTION ri
ry
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