2319 (2) /03 V& Igz92,;{/� '' . LOT No.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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W i �Z CITY OF CUPERTINO
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� O � Sanitary No,
3 U AUV . Wnd _, 196w Permit No
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° Application is hereby made to the City of Cupertino for a permit to install plumbing
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and/or,,*fixtiires^hsted'on the reverse side hereof, and agrees to install said prices
'z < and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other laws applicable thereto. .
J~ Use of Premises
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O 3 Owner MAIL Address—
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Jo BY-01 � �— Address
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Phone
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o to�, State License -Approved
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UNITS Fli Es UNITS1 FEES
SizWater Heater — B
Water C onsets— Materia ;T
Wath Tubs / To Curb
Showers To Prop. Line
Lavatories To Existing
Kite en Sinks Not Conn.
Dish Washers 1 Sewer Boxes
Waste Disposa s
Wash Trays STORM DRAINAGE
Washing Machines Size
'skater Softeners Material
War Sinks To Main Drain
Com . Sinks, rays To Curb
Dental Units _
rits ing Fountains
F oor Drains WATER SYSTEM
ee peril s Size j Y _
Restaurant Sinks Material
an. raps TOTAL FEES
riI' s Fixture Fee ,f?J
rea ruins Main E in Fee
aker Leaders Storm Drain Fee '
Sprinkler Vnives Water Sys. Fee
Permit Fee ,7.®
TOTAL TOTAL FEE 7,UIV
RECORD OF INSPECTION
Underground Rough...
Partial Rough.. �'—
:Rough, Complete_
.Main Drain
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Bldg. Dept
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No.Z4-1,77............
21�pllmbing Fined Plumbing P it N6.>--1..q............
t No. .....
Owner or Tenant .:...... ......... ................... ................... ............. _.:.. ... ......... .................
At ..........................1......C) ...... ...c....._
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Tract .......... . . ...................... .......... ............... ... ............ . ....... ..... ......
Date Connected .............:........-............ ...0(..'_.......................... .... ...
Date Final'!.!............................................
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............... ...(.6
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.111 7/63-IM PLUMBING INSPECTOU 41-IN