1757 lDss-o 0i Vj'
NO. S LOT NO.
?R
APPGICAT ON FOR, PLUMBING PERMIT
;1 AUG 27 2 IT'S of CUPERTINO
Date l9 2.. Permit No.
CITY OF CUYLKIINU
pee $ ��
Application is hereby made to the City of Cupertino for a permit to install plumbing
\i) pipes and%or fixtures listed on the reverse side hereof, and agrees to install said prices
jand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises a6� �N stn 2�
v
ti Owner Address
ere SOFT WATER SERVICE Address
1040 L�rY�iNl9GvdFYAp
Phonerttpl.�u, �,ts.,.«i Approv
P MBING INSPECTOR
URNS MBE M IN RAIN
UNITS I FEES JUNITSFEES
Water Heater II Size
ater. Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories II To Existing
Kitchen Sinks 1I Not Conn.
Dish Washer, BoxEB
Waste Dials I1
'Wash TAItys STORM DRAINAGE
Wasa ng Machines Size
'tet SoEte ers Material
Bar Sinks - To Main Drain
Comb. Sink a Trcys� To Curb
Dental Units
Drinking Fountains _
Floor Drains WATER SYSTEM
Hoppers ( Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals II Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vows I Wit Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Com let _
Fin __—