688 (2) K.� LOT NO, 66
NO. STREET
APPLICATION FOR PLUMBING PERMIT
ITY OF CUP ERTINO
195_ Permit No.
rim Fee $ p—O
CtT*Cl�� i FbER V0he City of Cupertino for a permit to install plumbing
pipes and or fixtures llste on `t a reverse side hereof, and agrees to install said prices
uj 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 Premise
a 7
N Owner &4/SsL ,; Gd Address
By /!lam 1�/77 !� _ Address L �,
CONTRACT kAGENT
Phone 3 — O Io�/ Approve .�
PLUMBING INSPECTOR
I
TURES NUMBER MAIN DRAIN
I UNITS FEES. it !UNITS FEES
Water Heater i I Size
Water Closets �` �� Material
TZ
Bath Tubs �� To Curb
Showers ! 11 To Prop. LineoeT
Lavatories To Existing 11 —
Kitchen Sinks �� _ Conn. Q� p C�afiJ�,
Dish Washers I SEWER BOXES
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines ��I, Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays) To Curb �_
Dental Units —
Drinking Fountains '
W—M
Floor.Drains . 11 WATER SYSTEM
Hoppers Size I
Restaurant Sinks Material iQ
Sand Traps 11 TOTAL FEES
Urinals 11 Fixture Fee dD o
Area Drains �� Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives I I Water Sys. Fee O�
Permit Fee p
TOTAL �� TOTAL FEE �p
RECORD OF IN PECTION
Partial Roughz_g
Rough Completed
Final ���
.` Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. ....&71,.-1
/ r,��1l.._.._....
[J/Plumbing_ Final Plumbing_ Permit No- ----A(�(.(Z/..............
Lot No. ...... to.. :.........
d
Owner or T/e�nant ..._/ �j .... ... ..1/.. ��w.. . .......... .�_...--
At ---
Tract .....
..�y/.. .v�./�1��...'../.J4-r. .C/..�tCatSa.,--- -..................................-
: _...�`<'*lld-�
Date Connected ..-`-----..s,..:pr.7�.......... .......................................................
DateFinal ............_.............- /---------.._-------------------
.....----- . . .. . .. ............................ '
P .]MBING INSPECTOR
III 7/59-500 -