639 (2) LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMITf
CITY OF CUPERTINO
Date~� �C_=i `� ='� 19S_ Permit No.
+SfJAN LO 1V-U ` k" Fee $ .5
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes.and/o�fixtures listed.1,the reverse side hereof, and agrees to install said prices
and/,or,fixtures nc
in•accordae.w4t Ahe provisions of the Plumbing Code of the City of
Cupertino, and all other laws
//applicable thereto.
Use of Premise
;.a
v
1 Owner Address
By _ Address
CONTRACTOR, AGE
Phone ApprOyhh . '-u
•PLUMBING INSPECTOR
j ..
LURES NUMBER 11 MAIN DRAIN
4 I I UNITS FEES UNITS FEE!
Water Heater Size
Water Closets Material
` Bath Tub's To Curb
I Showersd To Prop. Line
Lavatories To Existing
Kitchen Sinks � Conn
Dish Washers
Waste Disposals
Wash Trays 4w STORM DRAINAGE
Washing Machines ! �I Size
Water Softeners � / � �� Material
"Bar Sinks To Main Drain
Comb. Sink s Trays I 11 To Curb
Dental Units i 1 11
Drinking Fountains) I
Floor Drains WATER SYSTEM
Hoppers I Size
Restaurant Sinks Material
Sand Traps 11 T 'AL FEES
Urinals Fixture Fee b
Area Drains Main Drain Fee 100
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee I d Q
Permit Fee a
TOTAL TOTAL FEE Sd�
RECORD OF SPECTION
Partici Rough (1 � --
Rough Complete
Final;' 17 !�
Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. ..../._/o../_7...........
Plumbing Final Plumbing Permit No. ....C
-- -- - ------
Lot No. .......P67-
Owner or Tenant ....k-xon
....Az-c ..................
At ..... .............. ....
...........................................
..............................
Tract .......... 41
......................................
......... ............. 19-6.9.
Date Connected ... ............. --��,�079........ .....
DateFinal .............................................. ............ .............................
............ ....... ..... . .... ..
WBING INSPECTOR
P"''I 1 1 7/59:500