51126 (2) 22378. Salem LOT NO.
NO. STREET
PPLIATI0N FOR PLUMBING PERMIT
`� CITY OF CUPERTINO
/CCT 27 1966 t'�; � /i�
Date Oct. , 21 lyaG6 Permit No.
CITY OF CUPERTINO Fee $
p Application is hereby made to the City of Cupertino for a permit to install plumbing
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
yp Cupertino, and all other laws applicable thereto.
Y, Use of Premises
u
Owner Stephen Chelbay Address 2237 A . Salem
By Culligan Water Cond Address 380 E. Evelyn
cocToa, wnexr _ s
Phone 736-200 Approved�I _� •. !✓,
PLUMBING INSPECTOR /
—TIRCURES NUMBER MAIN R IN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Traysl 1 11 To Curb
Dental Units
Drinking Fountains 1 11 _
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Dra—msl 1 11 Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives II Water Sys. Fee
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final