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No. Street Lot No.
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IXP TION FOR PLUMBING PERMIT
CITYOF CUPERTINO
D 4E§C Z29 1970 Sanitary No. �^
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�F. }{g�196_ Permit No.�//p
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Applications is hereby made to the City of Cupertino for a permit to install plumbing pipes
Is I„ and/or fixtures listed on the reverse side hereof,..and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
t'o laws applicable thereto.
°.
;: 8 Use of Premises
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cd Owner / ` �"— Address /�.S/7 eeliZ�-'
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rn By Address/n -17
3 Contractor,Agent
0 3 Phonee�'j1 .S+W
State License ��llsi�GJN!/t/ Approved
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop.Line
Lavatories To Existing
chen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Thain WATER SYSTEM
Hopper Size
Restaurant.Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water
Sprinkler System Water Sys.Fee
Relief Valve
Vac Breaker
Skimmer
Filter
7/
Permit Fee s
Total Total Fee
CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE
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Job Located at 1,-),5-1-17----Va,,fo,-4
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You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the inspector.
252-4505 Date: . ......1.a.':1-f ?0
City Telephone Inspector: ....