2606 (2) S ..#Drive LOT NO.
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6
FEBA1P1'FATII, FOR PLUMBING PERMIT
CITY OF CUPERTINO
Datp!�Yz�i.�'-APER 4 ! 195_ Permit No. '-2 o
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.
Use of Premises RPRidnn t%
a
v
Owner Ward Crump
Addrespo Box 634 Cupertino
Bycr Admkk Addres
GO& TOR, AGENT W
Phone Approved_ `
PLUMBING INSPECTOR
--MMURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closets Z Material G>�
Bath Tubs To Curb ✓�
Showers To Prop. Line
Lavatories 1 3 To Exis in
-Itchen Sinks of Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
-Washing Machines I 1 11 Size
Water Softeners Material j
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units li
- Drinking Fountains ;I
Floor Drains 11 WATER SYSTEM
Hoppers Size
Restaurant Sinks 11 Material Gp /,eo
Sand Traps 11 TOTAL FEES
Urinals 11 Fixture Fee /y/p/J
Area Drains 11 Main Drain Fee Z,"
Water Leaders Storm Drain Fee
Sprinkler Vaives I Water Sys. Fee
Permit Fee ;7-. 0 0
TOTAL /n �pE TOTAL FEE /S/00
RECORD OF INSPE TION
Partial Rough
'- Rough Complete - -
Final —/17--