1710 (2) LOT NO.
NO.' STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERT[NO
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' 195— Permit No.
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CAI AN H IM Fee $
' Wpplication 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
T 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 4M14
r 1ez
Owner G ' Address
By - - Address
CON TR R, AGENT
Phone �� to- Approve
f(:
PLUMBING• ? P
�I�T-URI: NUMBER 11 MAI ' N'.
UNITS I FEES II 1 UNITS FEES
I..
Water Heater I SSite
Water C osets t) MateriaU''. y,
Bath Tubs yDd To Curb ••„
Showers To Prop..Line';�,�•�
Lavatdries l 6-1 :5- To EkistirjA-,;,;h' :.I
Kitchen Sinks e/ or1I Not Corin, .y:!, j T,J
Dish Washers
Waste Disposals
Wash Trays 1 II STORM.--DRAINAGE
Washing Machines f h,!) Size i >i'J-&
Water Softeners Material', r.•1•;,.
Bar Sinks II To Main,Drain
Comb. Sink s Traysl II To Curb`•
Dental Units
Drinking Fountainsl III
Floor Drains WATER SYSTEM :1
Hoppers - Size't''.'>i ?• '.`.f
Restaurant Sinks Material"
Sand Traps TOTAL FE
Urinals I Fixture,Fee;• ?.
Area Drains Main Draih Fee.'_` �f py
Water Leaders Storm Diain Fee.,�
Sprinkler Varves I I Water Sys. Fee"
i I'
• Permit Fee '
TOTAL M TOTAL'FE4
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final
Bldg. Dept.
Office Copy
BUILDING 'INSPECTOR'S OFFICE
CITY OF CUPERTINO
F -11--�/.....
] Sewer Connection Sanitary Permit No. ......
[g—Plumbing Final Plumbing Permit No. ...../7,40......
.........................
Lot . .....
Owner or Tenant .... . . .. ..... ............No................................
At -----
V.......... ............ ..................**......... ..
Tract ....................................... ......... .................................................
DateConnected .................................................................................................... 19
3.
Date Final ......................... ,, " .. .I-,
....... . ................................................
PLUMBING INSPECTOR
111.7/61-500