637 (2) LOT NO. ,
STREET
APPLICATION FOR PLUMBING PERMIT S
J 4%!„ I t Y OF CUPERTINO
el
IAN 20 1,60 ?
Dat 195 Permit No. J
t 0?Fy r x-11�77 1� Fee $4.
Application is hereby lrAa t�thne 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.
Y, Use of Premises
'a"
N Owner!a!LIAifJ C�.s ` Address
By Address
NTRACfOR, AGE r WILLIAM D. 6Ery ICH
Phone Approved
PLUMBING INSPECTOR j
FIXTURES ,NUMBER I MAIN DRAIN
I
I Uri Ts I FEES II IUNtrsl FEE:
Water heater % Size
I Water Closets _� ,�� Material VI
Eh T'ubs. � � � �� To _Curb
ers11 To Prop. Line
f Lavatories I J? �� To Existing
Kitchen Sinks Corin^•,, [iAi� J_
Dish Washers
Waste Disposals l �� �•
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb _
-T
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size �•
Restaurant Sinks Material
Sand Traps TOTAL FEES T
'Urinals Fixture Fee L/�s2Q
Area Drains Main Drain Fee lU D
Water Leaders Storm Drain Fee
Sprinkler VaLves I Witer Sys. Fee U
Permit Fee /n
TOTAL 11 TOTAL FEE _("O
RECORD OF INSPECTION
Partial 'k ough i
Rough Compl t
Final t; . - 7A — —s
Cupe-'V' Sanitary _
.TClt Fice,77o_Py
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. ....
.........................
Q/Plumbing Final Plumbing Permit No. .....G0�7
Lot No. ......p.3
Owner or Tenant ... �1/(.Llaj..S}.4� .. .... . .. . .. ....
.. . ... ....
At .......-:L./7Q7 ..'-. ... .. .... ,au,
..............
Tract .........`l...�Y..' ..
.............
................
Date Conneded -----.....................................
.�. j..----9.....:---........�--......_................ 19.Go
Date Final 'L.^7 ............ 19. .
....................... ....................
I — '
.........................
MBING INSPECTOR +
111 7/59-500 orli