2594 LOT No. L- .i.. ?/•y
NO.
® PLICATION F_OR' PLUMBING PERMIT �
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W ' P�CUPERTINO
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r o �/ Sanitary No.
o j Date n, rri 4if��i'pg6t`- ` Permit No
3 U I I t,Uf �-I�i '
W a Fee $
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or/fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of Prem'ses ✓tip—'�"^��-""`�
0 3 Own er ��z.a ��3��/ Address
z By '=� O�d� Address
O CONTRACTOR,AGENT
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Phone �
ao State License/a S� _Approved <'
-U PLUMBING�It55PECTOCR
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FI. R UDtBER _RKINTRAIN
UNITS FEES UNITS1 FEES
Water Heater Size
Wate; Closets ^ sy Matcna': 7
Bath Tubs r'V To Curb
Showers / j. -v To Prop. Line
Lavatories ^ per, To Existing
Kitchen Sinks � v Not Conn.
Dish Washers Sewer Boxes :ry
Waste Disposals _ 9p
Wash Trays 77STORM DRAINAGE
Washing Machines Size
'Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers • Size r
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee >ti
Water Leaders Storm Drain Fee
Sprinkler Varvcs Water Sys. Fee ! v
Permit Fee �2
TOTAL +v TOTAL FEE /7 ✓
RECORD OF INSPECTION
Underground Rough...
.Partial Rou_gh..
.Rough. C plete..
\Iain Drain
Bldg. Dept
Gffis Copy
BUILDING INSPECT'OR'S OFFICE
III CITY OF CUPERTINO (�
Sewer Connection Sanitary Permit .........-
Plumbing Final Plumbing Permit No.f4..................._......
Lot No. ........ ! -
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_ t,.. A 1
Owner or Tenant .........-------.� - -1�- ------ _..---':L..�.....---�- '• �w�`--------..._.......
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At .............. �-.. . ...
Tract --- ----------------.... ------ "]c..,M...g;_.------ ""`�"_'*........---------------------
DateConnected ------ ------------------- ------------ . ..---..a[ ---------------------------- - 19---T�...
DateFinal ............_..._..........._.........._---- --
(PLUMBING INSPECTOi�
III 7/63-IM
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