2227 (2) &IlatVIFOR
COT NO.q PLUMBING PERMIT
Ul. L+ 1963OF CUPERTINO
Y
°a / Sanitary leo.
0 a Date S 1963 Permit No.
LL CITY OF CUPERTNI T; Fee$ Z(Q -
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< W _Cupertino, and all other laws applicabI thereto.
Use of Premises
00
Owner n.r �/ /
o
/d -t-4 ddress o11
o a _..00 A
z_j / n A
J z By ,[ilvN-�L__tai-E � Address
0
3 �
CONTRACTOR,AGEN'C
- 0 Phone
. z
am State License Approved
fONTR A(ri'Oq Af.FNT
PLUMBING INSPECTOR
BER N
1'1.\I UIQ : +
UNITS FEES UNITS FErs
Water Heater / ,Q U Size ,do
Water Closets 3 J. a O Matcrai C=
Bath Tubs / pp To Curb
Showers / , 0 0 To Prop. Line
Lavatories 3 a J To Existing
Kite ren Sinks / .d 0 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
\ as�g Io1Rachmestl Q Size
'20at r Softeners Dfaterial _
Bar Sinks To Main Drain
C ttC mbSiirSink c Trays To Curb
Dental Units _
Dri��P'ountains {
Floor Drains WATER SYSTEM
h oppers Size
Restaurant Sinks Material .OQ
an raps TOTAL PEES
❑t r oaf Fixture Fee
Tr—e,—iffr itns Main Drain Fee y �'
Water Leaders Storm Drain Fee
Sprinkler Vowes Water Sys. Fee ='
/
Permit Fee
TOTAL / /rtl 0 T' TAL FEE
RECO O INSP CTION
Underground Rough...
.Partial Rough..
N'lain Drain
Pined... I I