2614 LOT NO,
,1APPLICATIO11 OR PLUMBING PERMIT
" 1964 CI--Y-Op CUPERTINO
Z
x o Sanitary No.
o Date DTT }- gip€ T..�;.96 Permit No cp6/
W LL Pee $ 3`_
= O
Application is hereby made to the City of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
�. Use of Premises
00
� 3 Owner •1
v
� N Address
ZJ (.1
J z By tti 31 ° 4f• ' t ma� Address 1 5�( C; &e-P t.tl Otd. g : cl.
H CONTRACTOR,AGENT
Phone
w Z /
ao State License I f s 1 �% �% Approve
�-U PLUMBING INSPECEOA
F
IXTURES Jf
UNITS FEES UNITS FEES
WateSize
�X'atMateria!Bath To Curb
ShowTo Prop. Line
LavaTo Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
�r,,, C Main Drain Fee
Water Leaders Storm Drain Fee
�p mkier,1,1alves, Water Sys. Fee
C Permit Fee oa
TOTAL TOTAL FEE c/O
RECORD 9F IN ECTION
_Underground Rough... .Q.w`
Partial Rough..
Rough. Complete..
Main Drain
Final...