1635 (2) LOT NO.
NO. STREET
D fLlFOR PLUMBING PERMIT
V+w XUPERTINO
Date
�JUL 5 /6.3s
19�� Permit No.
CITY OF CUPERTIN Fee $ Z. .'d
Application is hereby made tote City of Cupertino for a permit to install plumbing
pipespand%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;ofj� 0(y of
MN
?t? Cupertino, and all other laws applicable thereto. S�Ff WATER°1N3�ALLATdS
KEW S . g701e Ave•CY 46183
&� Use of Premises po�i/lGz e—G
t San Jose
/>
� Owner !/ Address
;1. By Ir u� Address)dj
CONCTOR, AGEN70or
Phone i < Approve
PLUMBING INSPECT00.
FIXTURES NUMBER " ri"'MAIN DRAIN
I UNITS FEES IUNITSI FEES
Water Heater i I Size
Water Closets I I Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks_, II Not Conn. lit„
Dish Washers
Waste DisposalsWash Trays Trays II STORM DRAINAGE-
Washing Machines II Size
Water Softeners �I Material �.
Bar Sinks I To Main Drain
Comb. Sink s Trays To Curb
I Dental Units.
Drinking Fountains 1 I,I
FlooryDrains WATER SYSTEM
Hoppers I Size 111
Restaurant Sinks I 1 II Material I �
Sand— Traps TOTAL FEES
Urinals f Fixture Fee
Area 15,a—,nl 11 Main Drain Fee
Water Leaders 11 Storm Drain Fee I •„%
SprinkleryQ. I II Water Sys. Fee
11 Permit Fee
TOTAL / J—q TOTAL FEE
RECORD OF INSPECTION
Partial Rough
I. Rough Complete �
Final A
. t