1301i o � 6& I C. Es T A 1 `i Dr, NO.
NO. STREET
AON14111F.
R PLUMBING PERMIT
pCUPERTINO
F �s�
Date 147
(A
Permit No.
CITY OF. CUPERTINO Fee $
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.
Use of Premises-
1-4
remises
�oIFr WATfPm SERVICE.
Use
r,
N Ow `
W 5rCV1 V 4 S Address
Q By A w e S p Fr UJA tE R Address
CON OR, AGENT
V % Phone t d Approved
PLUMBING INSPECTOR
Ab
FIXTURES
NUMBER MAIN DRAIN
Water Softeners
UNITS I FEES I I UNITS I FEES
Water Heater
I II Size
Water Closets
�� Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
I I II Not Conn. I 1
rs
aste
DRAINAGE
wasning macnlnes I
1 11 61ze
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
�I
Drinking Fountains)
I Il
Floor Drains
WATER SYSTF
Hoppers . '
I �� Size
Restaurant Sinks
:Material
Sand Traps
TOTAL
Urinals
Fixture Fee
Area Drains
Main Drain Fc4
Water Leaders
Storm Drain Fe
Sprinkler Vaives I
I II Water Sys. Fee
FEWER BOXES 1
I 11 Permit Fee
RECORD OF INSPE TION
Partial Rough
Rough Complete _
Final j'