1596 (2) S 0 LOTNO.
NO. ITREET
XN"® A N FOR PLUMBING PERMIT `
CITY OF CUPERTINO
f JUND 19R2-19 . ((��, /
Date , 19S_ Permit No. ��7 6
CITY OF CUPERTINO Fee $
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 Premises
Owner 0 Y 1 [D646Z Addr UC I V
By W J L7 L5._ �a wJtd2 Address
CONTRACTOR, AGENT -jj�
Phone G Approved
PLUMH3NG INSPECT
SURES NUMBER MAIN DRAIN
I UNITS FEES I UNITS I FEES
Water Heater / Size
Water Closets Material
Bath Tubs / To Curb
Showers To Prop. Line
Lavatories To Existin
',Kitchen Sinks No Conn.
Dish Washers SEWER BOXES
Waste Disposals
Wash Trays STORM DRAINAGE
Washing MachinesF Size
Water Softeners Material
Bar Sinks To Main Drain '
Comb.'rSink�&Traysi To Curb
Dental Units I1I
Drinking Fountains 1 11
Floor Drains WATER SYSTEM
Hoppers
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee / t O
Area Drains Main Drain Fee.
Water Leaders Storm Drain Fee
,Sprinkler ValvesI I II Water Sys. Fee • 00
11 -Permit Fee - / O O
TOTAL 11 'TOTAL FEE j , S p
R O D 'ECTION
Partial Rlh
Rough Com lete �10
Final
-'Bldg. Dept.
'Office COPY
BUILDING INSPECTOR'S OFFICE--,
CITY OF CUPERTINO
I r. '..
j] Sewer Coritiectiori Sanitary Permit No. ...:_ �� .....
[ Plumbing Final Plumbing Permit No. ..:/
Lot No. T.............
Owner or Tenant ...... .. - -. _-.- , , .
...
At
_ --
Tract .............. --- _ V5&
.....— _ _-.. ........................... .. ..... --- ---..:--
Date Connec ...... .. -- ...... ..Date Final ....------....--•---...'---- - '............._---....---.. ..._---..------- 1949-.
PLUMBING INSPECTOR
.111 7/61-500 - F'_:d. .. ,`.i;•�'�