1279 (3) ILIg70 G . ,LOT NO. n '
i NO. -'STREET
PLUMBING PERMIT'`'
4 .3
® 1 F;CUPERTINO
Date �� "' 19 � Permit No.—
CITY
o.CITY OF CUPERTINO Pee I
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. . '
c Use of Premises I
:a 1
:: Lr,
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I Owner�l PL ( I Oti� S Address CA�q_
�0 6-� Address O' (b 2
CONTRACTOR, AGENT -
.�• Phone . -.f; 4O'O _ APpro
PLUMBING INSPE T R
FIXTURES NUMBER MAIN DRAIN
UNITS FEES IUNITSI•FEES
Water Heyser fII .Ssze 4 .1
Water Gosets t I ��- Material ' C:01
Bath Tubs I / To Curb
Showers : / II To;Prop. Line I
Lavatories 111 Taj Existing qs
Kitchen Sinks r II No on
-Dish Washers
Waste Disposals I J I
Wash Trays ( II (STORM DRAINAGE
Washing Machines / II„Siam I {
Water Softeners Material
Bar Sinks - II To,Main Drain I I
Comb. Sink w Traysl .To Curb
Dental Units ,
Drinking.Fountains I ;. II - ;, s
Floor DrainsWATER SYSTEM
Hoppers I I II, Siie
i Restaurant Sinks ---JI Material •' sF�d 1�
Sand Traps I II TOTAL PEES
Urinals I I II Fixture Fee I -
Arca Drains I r;Ma n Drain Fee
Water Leaders Storm Dram,Pee h
Sprinkler Valves I 'I Water Sys. Fee I '
R BOXES I I",'Permit Fee
TOTAL I1V I II TOTAL FEES
REC R OF TION
Partial Roogh
Rough Co let I
Final %!j