2031 (2) LOT NO. _
APPLIei4T10N/ FOR PLUMBING PERMIT
CIS
OF-CUPERTrNo
I � + r� fir/ ••��
Date -%�.�^��--•^•^+>^19 J
Permit-No. .p 3 t
ilN i t ur % W LI%1 . •i ' ' _
A, 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;.ind 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 A
a
'Oivner� Address �t-��t
y1,0 I 1 e Q Y _ Addr- SO t7 i OSZ r
CONTRACTOR, AGENT
Phone L 1 04- b'O _ Approved
L fEING INSPECTOR
FIXTURES NUMBERI MAIN DRAIN
! UNITS ! FEES 11 JUNITS! FEES
'Water Heater" / Size 1 4
"Water Closets 1
I Material G'1-1
':;Bath Tubs c- / I II To G—rb--j I
"Showers / . To Prop. Line,
,'•La bries .I GZ To to
4 PE.- n.Sinks / t Conn.. (a
• Di-sh Washers I ileal _ oxes i
Waste issa.'�.a 1. l
Wa'sHL4Tta" I STORM DRAINAGE
- .'
�g H4aehines Size I
�3teL Softeners, I Material
s - To Main Drain
To Curb,
, D inkingeFountains - II
foor Ura, ms _ I 11 WATER SYSTEM
Hoppers 61', I' I Size
'Restaurant"Sinks I I Material 1 CO(
Sand Traps TOTAL FEES
-.Urinals ,' - I I Fixture Fee
+Area Drains ,,. I Main Drain Fee I �+
*�WatcT.tLeaders I I _ I Storm Drain Fee
•Sprinkler V1wes I Water Sys. Fee
•� - Permit Fee
[TOTAL I I T TAT PEE 11
r
RE RD OF.INSPE I
,partial Rough
!Rough Complete
rFinal
Bldg. Dept.
Office Copy
k 'BUILDING INS CE,
CITY OF , RTINO,
r' Sewer Connection - ;.
❑ r ^ Sanitary Permit No. ..... ................
Plumbing Final Plumbing Permit No.
' .............
L o. .. ....I V�Ld'
Owner or Tenant ............... ' �
Tract .:.....................--.......... ` int
- --
.. -X�..:.Y........... `.i..... .�-�. EE
-,
Date Connected ........:............. .... : 19
.......... ...
Date Final ..........................
.... _
..... ---- --- .
LUMBING INSPECTOR C J}
III 7/6i-soo � -