1762 (2) t]z z 1 i l._l1_il/ �X ad l^*LOT NO. /a
NO. STREET
syzi `` '� S
c54tI TIION, FOR PLUMBING PERMIT
QTY OF CUPERTINO
f.?A U G 30 19.52
Date , 195- Permit No. / 7 & z
CITY 0r CUPERTINO Fee $ 00
r .
Application is hereby made to the City of Cupertino foi a�permittto install plumbing',
pipes and/or fixtures listed on the reverse side hereof, �nd•agreesao msfall said prices
and/or fixtures in accordance with the provisions of the YPl mly_ i g Code of the City of'.,
\ Cupertino, and all other laws applicable thereto. ,e.
q S
Use of Premises
/ c
Own Address -
B '� _.cAddiess I N�
CONTRACTOR, AGENT
' Phone �«, :5;, - _ "°'Ap roved
�'�• I •� PLUMBING INSPECTOR
L�
FIXTURES NUMBER MAIN DRAIN
UNITS FEES I IUNITS1 FEES
Water Heater Size
Water Closets MatefTa1-1 I -
Bath Tubs � . �� To Curb ":':,;.
ShowersTo Prop. Line
Lavatories To Existing 1.
Kit— chen}Sinks Not Conn. ,k.
Dish Washers I BEWER BOJ(ES l
Waste Disposals
Wash Trays STORM_r_DRAINAGE
Washing Machines l Size
Water Softeners Material
Bar Sinks To Main Drain -
Comb. Sink & Traysl �� To Curb
Dental Units 1I.
Drinking Fountains) 1 Il ..,-v, A,
Floor Drain's WATERt.SY9-.4...
Hoppers LS'ze-
Restaurant Sinks
Mitenal.p;'•r°;h't -SC ,�,,, ; ,
Sand Traps TOTAL;FEES
Urinals Fixture Fee.%: :7" 0
Area Drains Main Draihi:Fee f-
Water Leaders Storm Drain Fee
S inkier Val �� Water Sys. Fee l ,!ky
Al } -MPermit Fee
TOTAL TOTAL FEE "
RECORD OF INSPECTION
Partial Roue 7
Rough Complete "�•
Final