2667 20900 e' s Creek: Blvd. O,N,.
n APP%iDy
FOR PLUMBING PERMIT
R
m < 196 OF CUPERTINO
D
- ,(AP1
I o Sanitary No.
3/31
aJ Date I�etv
1-0196— Permit N
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3 < V
w w Fee $
T 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
a 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.
w x
Use of Premises Chlirrh
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3 Owner Glen Rutt Address 11741 Sharon Drive
oa
zJ1217 Dell Ave. Cam bel
J z By Wi nrhPctar Pl1rmhi no Address Camp
bel
3r378-7615
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2h0245
a o State License Approved
QU
Fix R . NUMBER M I R I
UNITS FEES UNITS FEES
Watcr Heater j Size q PUU
Water Closets Materia'.
Bath Tubs To Curb
Showers To Prop. Line t
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers I Sewer
Waste Disposals - l CGBoxes
Wash Trays STORM DRAINAGE
Washing Machines Size
Alater Softeners Material
W. Sinks To Main Drain
Comb. Sink & Trays To Curb
De ital Units
Drinking Fountains Z 1 p
Ploiir Drains Y WATER SYSTEM
Hoppers Size - r
Restaurant Sinks Material ,L>
San Traps TOTAL FEES
Urinals 2 a Fixture Fee
Area Drains Main Drain Fee
\t/ater Leaders Storm Drain Fee
�pP. lcr Vo 1 1 Water Sys. Fee p�
Permit Fee apl.Q
TOTAL y o e TOTAL FEE o
RECOR F INSPE ON
Underground Rough... _ ,
.Partial Rough- s-
.Roup om lete - -4Y/
Final._ '42 11