1500 LOT NO.--?)
NO. STREET
re-�PAJION FOR PLUMBING PERMIT
OF CUPERTWO
�TT
APR
F1�7f'1R9FRT'f�(�' , ,�z Permit No. �Jr44
VNO Fee$
CIRpTlic L i�l"iete6y+MaH P 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
U Cupertino, and all other laws applicable thereto.
v
L Use of Premises-ALC/DtMG�
u
h Owner CSiGr AT , AV0Ae-2TivS
Address /ii,At/17i.v u
gy 1011pvp /v/11 niF Address / <L
jh�,, CONTRACTOR, AGENT
SIV one F-G/ Approve
PLUMBING INSPECTOR
I 'I tJRNil MBE MAI ?
I UNITS FEES II IuraTSjI FEES
Water Heater I l Size yi1T
'Water Closets Material
Bath Tubs To Curb
.$hoovers To Prop. Line
�•,avatoriTo Existing
-Kitchen. Sinks No Conn
ilQis6 Washers -
�Waste'
W h Trays �� STORM DRAINAGE
�W'as hmg Machines II Size
Water Softeners - 11 Material j
Bar'Sinks �� To Main Drain
`,Sink a Trays I To Curb
'r Dental Units
Dnnkuag,Fountains� ( 40--'
Floor Na—jusj 1 11 WATER SYSTEM
'HoppeSize IEEE
Restaurant Sinks �I Material ���V
KSr a'nd"Crpps TOTAL FEES
Is�� Fixture Fee
t,1 ma LYramsj Drain: Fee oy
FWater Leaders I Drain Fee
Spn tiler Valves Water Sys.-.Fee � p p.,
Permit Fee ,p tY
"''0TAL TOTAL FEE
ECO D F I SPECTION
,partial Rough -
?Rough Complete
k9Final
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