2647 ��IL"NY,• Jf� 1�CLNpp,r RFj LOT NO.
NO. �l FOR PLUMBING PERMIT
eftm'AR
OF CUPERTINO
11 196 ��� Sanitary No.__
OJ Date 96 Permit No �2&:Ll/
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w CITY OF� CUPERTMO
o Fee $
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� App kation is hereby made to the City of Cupertino for a permit to install plumbing
oa 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
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Cupertino, and all other laws applicable thereto.
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w Use of Premises C
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3 Owner �iS7u,i..R�*-1 —+`/�4.s� Address
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a T By Q s. 14//f 160KAddress Ad. �k
3 a CONTRACTOR, AGENT J .5�9��fq CIR'&A,
— Phone r•�� �� }
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�^ I State License X07 Approved
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^ PLUMBING INSPECTOR
rIX R . NUM" MExisting
DRAIN
UNITS FEESUNITS FEES
Water Heater
Water Closets ,Bath Tubs y Showers Lavatories Kitchen Sinks . .
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
".Water Softeners Material
Bar Sinks To Main Drain
Comb. .Sink ,Trays To Curb
Dental Ilnits
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers. Size
Restaurant Sinks Material 4,q.4
Sand Traps TOTAL FEES
Urinals Fixture Fee 491p�
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
sprinkler Voivcs Water Sys. Fee
Permit Fee
TOTAL. _ TOTAL FEE
OF INSPECTIO
Undergroun K ugh -
-.Partial Rnugh..
Rough. Complet .
Main Drain
Final... ,(it --