NO PERMIT NUMBER 22731 I Medina Lane LOT NO. 16
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
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w < CITY OF CUPIRTINO
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x O Sanitary No.
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o Date 10-4 8 ermit No
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Pee S 140.0 d
Application is hereby Wi tltl it [ Cu for a permit to install plumbing
o a pipes and/or fixtures lis ed on the reverse side hereof, and agrees to install said prices
I in and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all ofjw,,tUdvs Rlpli1PERI TING
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Use of Premises Rec_ideaCe
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> 3 Owner Perrotti Construction Address2225 Grant Rd. ,Los Altos
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z By W.L.HICKEY SONS, INC. Address198 Commercial St.
3 o CONTRACTOR, AGENT Sunnyvale
— Phone 736-4938
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U 95122 WiL_1,1*1 D. 7--yEVICH
a o State License Approved
—U x PLUMBING INSPECTOR (�
FIXTURES 1
UNITS I FEES UNITS FEES
Water Heate 3.0"O Size 1/
Water Closets ,D'JLNot
erial C,
Bath Tubs a 3,eoCurb
Showers 3,e-OProp. Line
Lavatories .OUExisting
Kitchen Sinks a 3,rVConn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays I STORM DRAINAGE
Washing Machines 3,CU Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units elf
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /"
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee a o--0
Area Drains Main Drain Fee ,&V
mater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fe ,j tr-p
Permit Fee
TO-TAL --I TOTAL FEE D,
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final