51064 (2) ez LOT NO.
NO. STREET
® � IA N FOR PLUMBING PERMIT TY OF CUPERTINO
/JUN 7.n 1366 r
Date June 10 19566 Permit No.
CITY OF CUPERTINO Fee $10IV1
Application is hereby made to the City of Cupertino for a permit to install plumbing
10
H pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
M and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
U Cupertino, and all other laws applicable thereto.
u
Use of Premises
v
Owner K. Coolidge Address 22115 Clear-wood Ct,
By RW Water -Servigeigh,_ Address 243-B Moffett Blvd.
1
Phone- 967-4545 Approved .
I1. PLUMBING INSPECrO¢'
SURES I NUMBER 11 MAIN DRAIN
UNITS I FEES 11 JUNITS1 FEES
Water Heater Sae
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals II
Wash Trays .�, STORM DRAINAGE
Washing Machines Size
Water Softeners I 1 .00 11 Material
Bar Sinks �I To Main Drain
Comb. Sink m Trays To Curb
Dental Units
Drinking Fountains) II _
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
-Water Leaders Storm Drain Fee
Sprinkler Valves I I I Water Sys. Fee
Permit Fee
TOTAL 1 I 4.0OI TOTAL FEE 4,00
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final