1243 (2) LOT NO, S7
NO.
Ir GSA L T `�y{ FOR PLUMBING PERMIT .. _, h
SEP 2 6 1961 it OF CUPERTINO
Date 195_ . Permit No.
CITY OF CUPERTINO 'Fee $_J q�=
t Application is hereby made to the City of Cupertino for a permit to install plumbing
Mpipes 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
cl Cupertino, and all other laws applicable thereto.
Use of Premises
Owner&�,� PCOB�bro, Address
0
By - 1 Address
nA� CONTRACTOR, AGEN
I f Phdne Approved
PLUMBING INSPECTOR '
FIXTURES NUMBER MAIN DRAIN
I UNITS I FEES 11� ''•. UNITSI FEES
Water Heater .11 . 1 I Size ':I 4/ i
Water Ciosets -1 2 :Material C7,_r,
Bath Tubs I / 11 ,To Curbt 1,1
Showers .i I a 1 I•To'Prop: Line sl'1.�I
Lavatories To Existing•','
Kitchen Sinks / No Conn�p �
Dish Washers / .• -. .(, ; Oi I
Waste Disposals "St PS s '�'.�� 1
Wash Trays II , STORM DRAINAGE
Washing Machines See _ • �;r,
Water Softeners . Matecj3l • ,�x
Bar Sinks '- 1 11 To Main Drairi'll I
Comb. Sink &Trays I
11 To-Curb
Dental Units:_- I II •1'1- r_I
Drinking,Fountainsl - I II fi ;.Vi) t
—Floor Drains—1 . I WATER.SYSTEM
Hoppers
Restaurant Sinks
Sand TrapsI' II TOTAL',{FEES
Urinals � , Fizture'F��("
Area Drains .Main Diaii?,Feei I
Water Leaders Storm;Dr in.�Feer�
Sprinkler Valves I I I Water Sy .Fee 4%I O0
Permit Fee-',{{^tel_ /,OQ
TOTAL - - TOTAL'FEE)?
R CORD 9X L PECTION",jV_`}
Partial Ro,gh
i! •1 �t'
- t .., ". •i�. .ift•.^ ?.,:.. Cupertino Sanitary
- Cffi�,Copy
BUILDING._INSPECTOR'S OFFICE
OF CUPERTINO
Sewer Connection : ,Sanitary Permit No. �p-1 ...:._hh'-- :.....
dPlumbing.Final _ Plumbing Permit No. ..A¢S. J...'.,,..
L N i1,'.:
Owner orTenant =s
A §�
; s `'`;"_" :: . ...... . -..-. -ter--•--ti_. .:
�y
te
4 �• a Connecter ,..r �(iJ'/O .. .. .......................' ti"" 19f71-
Date [mal ::..... . .... ti"--------- IP -------
19
F 4
.� t ll
Ubfli l'VC INSPECTOR
tll�*t/GO-500>` 1' c , .