2477 •�� r LOT No.
P11NO
Q TR
R PLUMBING PERMIT
CUPERTINO
W V 5 99&3
Y o Sanitary Nu.
Date �t ,/ �7
6— Permit No. x` 7
LL CITY OF e�h Fee
O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of Premises .___ �✓.ti.�/• ,{:.��
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� 3 Owner- � 2A Address
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.By�����, Addresse��v/V'�/�•/ tri c..
3 < CONTRACTOR,AGENT T��
m i Phone.C4 •�- 2_ � 2j
ao State Licens X� 0/ . Approved .t� . )
Jb/ PLUMBING INSPECTOR
--
FIXTURLb— NUMBER
UNITS FEES UNITS FEES
Water Herter �
Size
Water Closcts S! 1 Material
Bath Tubs cry To Curb
Showers .y To Prop. Line
Lavatories <! To Existing
Kite en Sinks 7j Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays Z dt STORM DRAINAGE
Washing Machines rj ,2 Size
',Vater Softeners Material
liar Sinks To Main Drain
Comb. Sink s Traysl To Curb
Dental.Units.
Drin ing Fountains
Floor Drains WATER SYSTEM _
Hoppers Size
Restaurant Sinks Material
STTI rar pn TOTAL FEES
nnnls Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vnives Water Sys. Fee /
Permit Fee ?✓
OTAL 0.00 TOTAL FEE
RECORD OF INSPECTION
nderground Rough...
.Partial Rnugh.. �f�. ��„S
.Rough. Complete.._
\Main Drain� —
Final...
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