2733 LOT NO.
H° APPLIC Tl"ON FOR PLUMBING PERMIT
z < CITY OF CUPERTINO
E0 0,9Y 7 1994
r Sanitary No.
0 LL ��
3 a Date / 196_ Permit No
—ca-
LL CITY OF GumI INO Fee$ 0
° Apphcation is hereby made to the City of Cupertino for a permit to instal( plumbing
o a pipes an fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and- all other la applicable here
wx
w Use of Premises
00
> w
o
Owner Address
z <
� z B
J ° y CONTRACIO1,AGENT Address
3P
—
w z
ao Stat Licensr� < Approved
- 0
Lb
PLUMBING INSPECTOR
RUNITSFEES UNITS FEES
Water Heate SlzeWater ClosetsMaterial
h TubsToCrShowersTo Prop. Line
LavatoriesTo Existing
Kitc en SinksNot Conn.
Dish Washers Sewer Boxes
Waste Disposals
a(agh Trays STORM DRAINAGE
Washing Machines Size
Water So teners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units _
Drin ing Fountains
r oor Dntins WATER SYSTEM _
Hoppers Size
Restaurant Sinks Material
Sari raps TA L EES
nna s Fixture Fee . 0
rea rains Main Drain Fee .Ud
ater Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee ,00
Permit Fee .0 0
TOTAL 4o TOTAL FEE 0 0
RECORD OF INSPECTION
Underground Rough...
Partial Rough.. 1
Rough. Complete.,
Main Drain —
Final... — — _