1270 (2) EG �'a .. LOT NO. 4
�N DOS BET
APPLICAT O OR PLUMBING PERMIT '
SEP E B 1961 C F CUPERTINO
Dat vu
vur Frh-rjRjEn 111`IV 5_ Permit No. / Z7 O
�/�J Fee $ I
ry 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.
8 Use of Premises
Ow ' 10 A4 t S Addres Q 1 A
By W/Lt �1oNEs - Addre S� I DCZ
CONTRAcI'OR, AGENT
P�lone 6 c� _ APPro
// PLUMBING INS P R
SURES NUMBER. MAIN.DR 'IN•;,.:
I UNITS I .FEES 11 t#r IUNITSI•FEES
Water Heater Size ' 'tib;I *
Water Closets -Material . - tt;'G r
Bath Tubs / To Curb
Showers T i .To Prop. Lirie;', �(
Lavatories I 2L I II, To Existing . ' ;Ir
Kitchen Sinks / I N Con
"Dish Washers "' 'i• '.:
Waste Disposals y ,• P• '"SII
\\/ash Trays STORM DRAINAGE
Washing Machines / Size
Water Softeners Material , _•'. I
Bar Sinks - - I To Main Drain'
Comb, SinkTraysI To Curb
Dental Unitss I I
Drinking.Fountainsl I II
Floor Drains WATER SYSTEM(
Hoppers Size I3 —
• Restaurant Sinks rI II Nfateiial !• , 'GAL I
Sand Traps I I -.a: ITOTAUTEES
Urinals I I Fixture Fee
Area Diramr Maim Drain Fine•I /
Water Leaders I . I Storm;Drain Fee
Sprinkler Valves -II - Watey Sys. ,Fee- I /
WER Boxv / I 'Permif Feel _IWr,1
TOTAL- 11r) I II TOTAL EEE / 5U
T� RE OR OF CTION_P
f
Rouvh Roirete d
z - Cupertino Sanitary
Office COPY
BUILDING INSPECTOR'S OFFICE
CITY-OF CUPERTINO -
❑ Sewer Connection Sanitary. it. No. .. -
/h.
W*Plumbing Final Plumbing .Permit'No. .Lr'./�U'..........
Y
Lot N -17�f-_
Owner or Tenant .....:.............. ... -/ n ------...-....._.-......._---
At ...... 9. --; ------------ ---- ------ --------
Toad :...--------.., l..�C-'f z...... ..............:........-_._.--- ----- -
1
Date Connected ------------- = .. .. ....... . 4�.....- ,r -- ...... 19.�.�..
Date Final ..................................::.�e.��.,/ -:....... L�J� " .+
• ........................................ 19- ........, .
-------------------
PLUMBING IN§he-:TOR
III 1/CO 500;