2000 LOT NO. �5`Or�' '��i
ITEICAr:
/k'P_PLTitON.FOR PLUMBING PERMIT
�i 4---1' Ci4 4'OF,CUPERTlNO
C PPP III of
Date ^�95 ;-ivs�3 Permit No._ o?l9D0
i
C,T`f OF Cl1PERTt�'; 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
Cupertino, and all other laws applicable thereto.
:a Use of Premises 4ye 14
62
Owner/✓taCC� fYB vrmc o AddressZ-� �.P-
By Addressz2L2�i--
C NTRACI0 , AGENT
Phone �5�—r/S!�[ Approve
PLUMBING INSPECTOR
URES UMB- M DR
.__ UNITS FEES IUNITSI FEES
Womr Heater
I II Size "
ater C osets I Material
path T65I /;7 To Curb I I
Showers l II To Prop. Line l
avatories I I To EI ia� I °�
Kitchen Sinks I / I N9 Conn.
Dish Washers h�
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines I I II Size
Water Softeners I Material
Bar Sinks II To Main - !!t. ,
(otnb. Sink a Tr7y—sll II To Curb I_
Dental Units l l ll
Drinking Fountains) I II
Flgor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks I I Material
Sand Traps TOTAL FEES
Trinals I II Fixture Fee I i
Arca Drains I i Main Drain Fee I Z
Water Leaders I I Storm Drain Fee
rSprinkl� er Valves I II. Water Sys. Fee I /i
w~'-- Permit Fee Z•
'TOTAL I TOTAL FEE V6 �—
OF INSPECTI N
Partial Rough
Rough Complete_
Fi/nJal 1