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LOT NO. 7�
NOPSIEP1219W A PLUMBING PERMIT
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x 0Sanitary No.
LL Y 3.3
0 , Date Qk�}�; Permit No
w CUPERf O ; Fee
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
o 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
c w Cupertino, and all other laws applicable thereto.
LL Use of Premises '//L_ —
00
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0 3 Owner—&P---P—— e,._,d. Address,,sk—S'C N. ,✓
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J i By k r / (� Address
3 CON CII ASA OR, AGENT `
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Quo State License k 9 Approved C� E�
—�7,� PLUMBING INSPECCO�
FIXTURES
NUMBER I DRAIN
FEES UNITS FEES
Water Heater J Size
Water Closets MaterialBath Tubs / To Curb
Showers / To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
'.dater Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dentab Units
Drinking Fountains
Flopr Drains WATER SYSTEM
Hoppefs Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee o.
Area Drains Main Drain Fee L w
Water Leaders Storm Drain Fee
Sprinkler Vnivcs Water Sys. Fee (ed
Permit Fee
TOTAL /� TOTAL FEE
RECORD OF INSPECTION
Underground Rough... _//-3 7
.Partial Rough..
.Rough. Complete..
Main Drain
Final...