1319 (2) LOT NO,
NO. STREET
r® C ,j0N FOR PLUMBING PERMIT
caC iPF CUPERTINO /�
Date r NOV 9 1996'' 495— Permit No. 1:3 19
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QF Fee $
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Application is here bvPERlt6'flidCity 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
Cupertino, and aer laws applicable theret
8 Use of Premises a t Q-ze t 3 '
a
Owner Adiess
By 'X_ Address
U I CONTRACTOR, AGENT
I Phone )C Approv
PLUMBING INSPEC OR
J
FIXTURES NUMBER MAIN DR IN
UNITS FEES UNITSFEES
Water Heater Sae
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 Siriks To Main Drain
Ccmb. Sink & Trays) To Curb
,004
Dental Units FA
Drinking Fountains) II
Flour Drains 11 WATER SYSTEM
Hoppers Size
Restaurant Sinks A4aterial
Sand Laps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
rink) VaIves I II Water Sys. Fee
Permit Fee
TOT-AL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final -• 1 0