2702 as - VUR LOT NO.
APPLICATI , � FOR PLUMBING PERMIT
*0 a 'IAPB 17 964 CITY,OP CUPF.RTINO
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LL Date(�gw&jMUPCRe'1'j96� Permit No
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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
<w Cupertino, and all other laws applicable thereto.
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Use of Premises
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o a Owner /)IICT Address/5lD5;'A/ //l/il e fESiEX f f
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— 0 Phone X96 -39l --E
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oo State License �,Sa9,� Approved
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PLUMBING INSPECTOR
FIXI URFSNUMBER i
UNITS FEES UNITS FEES
Water Hearer % le)61 Size
Water Closets Material
Bath Tubs / G fl To Curb
Showers /,,70 To Prop. Line /
Lavatories 3 To Existing
Kitchen Sinks D� Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Waste Trays STORM DRAINAGE
Washing Machines 1,6c Size
Water Softeners Material
IBar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers. Size
Restaurant Sinks Material 9 v
—sa--J-Traps TOTAL FEES
Urinals Fixture Fee '//,�D
Area Druns Main Drain Fee a,0�
Water Leaders Storm Drain Fee
Sprinkler Vaivcs Water Sys. Fee /1(96)
Permit Fee
TOTAL //p TOTAL FEE Q
RECORD OFINSP TION
Underground
.Partial Rough..
.Rough. Complete.. _5
\Iain Drain
Final... L