1281 (2) LOT NO.
NO. STREET
` N POR PLUMBING PERMIT �
VOCT 2jg� TY OF CUPERTINO
2
Date , 195_ Permit No. �o�e
CITY OF CUPERTINO Fee
n Application 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto. ,,//JJ
Y Use of Premises A6'S v_[ "eL� �/
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By v m LN
COECTO , AGENT
Addr «i
CONTRACTOR,
Phone /?-_�- lll
APPr
PLUMBING INSPECTOR
. ._ ..
rs-u 2
I TUR= UM E M I R I
UNITS FEES I UNlTS� FF.E9
Warer Heater
/ 1 !! Size y'I
Water C osets 3 11 Material 7G/
Bath Tubs To Curb I !
Showers ( To Prop. Line !
Lavatories ! 3 �� To Existing
Kitchen Sinks / N nn.. Z /�
Dish Washers /
Waste Disposals F
Wash Trays RAINAGE
Washing Machines Size
fifer Softeners �� Material
Bar Sinks ��, To Main Drain
Crmb. Sink a Trays !! To Curb
Dental Units !
Chinking Fountains!
Floor Drains ! ! WATER SYSTEM
Hoppers If !
Restaurant Sinks ! ! !! Material �doyI
Sand Traps !� TOTAL FEES
Urinals !� Fixture Fee ! f 5 O
Area Drains ! ! �! Main Drain Fee I /,a p
Water Leaders I ! !i Storm Drain Fee !
Snrinklcr uri„cs ! I 11 Water Sys. Fee I /,o o
SEWER BOXRE 1,7.voll Permit Fee 5
OTAi 1 11 TOTAL pEE
RECORD OF INP TION/
Partial.Rol .-
Rough Complete 29
Final Z..
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O N
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