1376 � o ?,5'/ LOT NO.��.L�
1 NO. STREET
LI R_� PLUMBING PERMIT
F ERTINO C Z �
\ Date �IJA 196a Permit No. 1,576
/ 7
CITY OF CUPERTIgQ Fee
Application is hereby made to the Ity o upertino for a permit to install plumbing
ref 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
Cupertino, and all other laws applicable thereto.
u
Use of Premises
n Own c)J2— I Q N �� Address
By��f/�rf� i�_ Addres?
CONTRAC't00., AGENT
Phone' Approved
/ _ -6 L PLUMBING INSPECTOR
FIXUAES NUMBER MAIN DRAIN
UNITS FEES UNITSFEES
Water Heater I Size
Water Closets I z 1 11 Material e Z I
Bath Tubs / To Curb
Showers / To Prop: Line
Lavatories ; To Existing
Kitchen Sinks / II N4CCoon.
Dish Washers
Waste Disposals /
Wash Trays STORM DRAINAGE
Washing Machines ISI Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Traysl II To Curb _ I
Dental Units I I 11 I
Drinking Fountains) I I�
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Diaterial qpp�,�
Sand Traps TOTAL FEES
Urinals Fixture Fee / Q
Area Drains Main Drain Fee % , 00
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee /. (30
1�1MERBOXES / I z, Permit Fee /-00
TOTAL /ZMg-PI TOTAL FEE
RECORD O IN PECTION
Partial Rough U
Rough Complete
Final