1063 (2) /6�/� I �71�T LtlHy yD
LOT NO.
� NO. STREET -
T ON FOR PLUMBING PERMIT
21 ` V OF CUPERTINO `
Date (O 1 Permit No.
I / ... 4'}.�F GIS!�� Fee ffi 1&tIN `Application is is hereby made to the City of Cupertino for a permit to install plumbing
pipes ani/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. J
Use of Premises_ S� yZ�E ��r° /(Z
n, Owner, Address,
By !.s.--• Address
Phon r' „� Approved \
�� t I PLUMBING INSPECTOR
--MIXTURES UMBER MAIN DRAIN
UNITS I F'F.F.S 11 41 UNITS FEES
Wnter Heater I I I Size
Water Closets Material
Bath Tubs 4i's IF—To Curb 1
Showers 11 To Prop. .Lin 's. +J,,�
Lavatories ,. To Existinkp�
Kitchen Sinks / . . _N �nrir�^ "t� 4't X+=i�,�
Dish Washers / e',••t:;'
Waste Disposals �( �. .,.;+'• r..
Wash Trays STOR *'D '[NAGE
Washing Machines r Size ^yv, 1
Water SoftenersMaterial
Bar Sinks I To Main lltaigp�►t�1'�,
Comb. Sink a Trays To Curb,,,,,,
Dental Units ,'1
Drinking Fountains I Ilt;" ;'�'I
Floor Drains `WA$ER'SYS
Hoppers
Restaurant Sinks Maters1.' I•`q/�•
li Sand Traps 'f�Q,TALI•FEES
Urinals I I ,,//'0-0
Area Drains Main,Draih Fee'I
Water Leaders Storm Drain Fee I
Sprinkler Naives Water Sys. Fee r eV
(' Permit Fee I bat
TOTAL TOT4L FEE
RE ORP OF NSION
Partial Rough 2/
Rough Comp,ete
Final Z
Cupertino Sanitary
Office Copy
t; BUILDING INSPECTOR'S OFFICE' '' ' fi
CITY OP CUPERTINO
F-1 Sewer Connection Sanitary Permit,No.-...Z.-/-2-Y7.........
F1' Plrfmbing Final Plumbing-Permit No. ...,lf!-..... ..I......
Lot No.
' Owner or Tenant.. � .......?T'... " _'......................................
. .?✓. ...^.. .. ... .... "/{TraCt ...... ......... . !✓..-: .-....... r--....................-......-..-..-........
DaeConnected ok.-
e '
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Dat „I'tnal ................................. . ...... . . .. ............................
.-. ...-.-........--.. i ..---
�. ,
GING INSPRCI'OR
ill 1160-500ff�///