1770 (2) /42-23. I V Lel )/-"'a, LOT NO.
NO. STREET ,
�AP,RyLICATION. FOR PLUMBING PERMIT
i� CITY OF.CUPERTINO
DateVAUG U r J0 194 L Permito. 1 -7 0
N /
CITY OF C11PERTINO Fee $
U, oa
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 Premise
:a /
v Owner/'L P Address l'�Y
B Address u�
CONTRACTOR, AGENT
Phone�>\ `f—3 v➢7 Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
I UNITS I FEES 11 UNITS FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not n lCJ„Q ,Q
Dish Washers I it SEWER BOXES
-s
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines �I, Size :
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink &Trays To Curb
Dental Units i I �
Dunking Fountains)
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals FixtureFee I '
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
-Sprinkler Valves I Water Sys. Fee
,•� �� Permit Fee
TOTAL TOTAL FEE
RECO D i TION
Partial.:Rough
Rough',Complete
Final •
Bldg., Dept.
Office Copy
.. ..•., BUILDINGK•INSP.ECTOR'S OFFICE
""•" CITY..OF 'CUPERTINO
F-1 Sewer-,Cormection - Sanitary Permit No. .p;(..ZD--.ql..........
4!100'Plumbin' Final
f - a � gPermitt No. J
Plumbin / 0
........
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Owner or Tenant?..... ___.....__..........--
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Tract........... ..... .. .. . ... ... ... ..................................-
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Date Connected -- - � - �' � _� •`.:' �
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Date
------------------------------ ----Date Final ..............'---------------._/:_. ------------------- -------------------- 14R
PLUMBING OR
00
:111 '7/61-5 "