51121 a No. Street �.. Lot No.
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6 do OF 0 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
�f. EVe �.i-(i S , 196 Permit No. k Z
Fee$c3 s Q
Application is hereby made to the City of Cupertino for a.permit to install plumbing pipes
4, and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
�'P laws applicable thereto.
A w
'3 use of Premises
pU
6 o Owner Address
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M By -21Z4A. Address
Contractor,Agent
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Phone SS- /"/ ,36 4f-!PP!
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State License ved i
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / .So Size
Water Closet Material
Bath Tub To Curb
Shower To Pro. Line
Lavatories To Ex' '
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size _
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee / sa-
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee az
Total 1,50 Total Fee ,
CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE
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4 DeparfineM
Job Located at !-............93 So. a 4A
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You are hereby notified that no more work shall be
done until the above violations are corrected. When i
corrections have been made call the inspector.
252-4505 Date: i ... .`.1.- .-7/_
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City Telephone, Inspeclor:S}r-.. ✓ K: ,T-.