2160 (2) Zpz�h I C/ j� QJ /V 1J ror No.
NO. TR ,T
® Ti OftFOR PLUMBING PERMIT
m a CI) OF CUPERTINO
x o ' JUN 1t) C Sanitary No.
1963 _
a Date 196 Permit No a
TY U� ,�UPF��Tik�l�l Fee $
' o App icatton is ere y ma e o the'City of Cupertino for a permit to nstalf I plumbing
o a 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 a licable ereto.
0 o Use of Premises
o .
Ow dressleO
z J /.
z L/°E(/y IP =�A,ENT Addres��lJ/7/l��i�/�/.l1////i .
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W i Phone�s/ L' �%
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Q.s State Licens -Approved 7 A -.e t�
PLUMBING INSPECTOR
I11X-I URES NUN BER 11
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Materia; OAU
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
".`Dater Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units _
Prinking Fountains - {
Floor Drains WATER SYSTEM
-Hoppers Size /,
Restaurant Sinks Materia . (�
San .Traps TOTAL FEES
Urinals Fixture Fee
Area grains Main Drain Fee „
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee ,
Permit Fee r
TOTAL TOTAL FEE
RECORD OF INSPETIO
Underground Rough.. '
.Partial Rough-
16.—ugh Complete..
Main Drain 6—,�;? - i `-
Final.... 1 "2- •%
Bldg. Dept
Office Copy
WILDING `I.NSPEC OWS OFFICE
CITY OF CWRTINO
Z
7,
F� Sewer Conn&tion Sanitary Permit No. ................................
� Plumbing Final Plumbing Permit Wzc7:'_ 1
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17 .
Lot No. ... ................
Owner or Tenant .......... - -------------- -.......
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Tract ........
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Date Connected .......i-----------------------------IL ......
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DateFinal- ---------------------------------------------------
14
Ill 7/63-IM PLUMBING INSPWTOR
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PLUM