NO PERMIT NUMBER 22763 I Voss Ave. 30
OT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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a 14 1960 ern tNO
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i LL Pee $ U, o (/
' 0 Application is hereby- made jj,o J�le�CiAef �r[j�f P f ermit to install plumbing
o < pipes and/or fixtures listed oiS�t{Ic reverse sig er�0111r OUTees to install said priocs
F 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.
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11 Use of Premises . Residence
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> 0 Owner Perrotti Construction Address 2225 Grant Rd. ,Los Altos
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j o By W.L. HICKEY SONS, INC. Address 198 Commercial St.
3 F CONTRACTOR,AGENT Sunnyvale
— W Phone 736-4938
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a o State License 95122 Approved
PLUMBING INSPECTOR
FIXTURES
JUNJITSF;EES UNITS FEES
'Water Heate $iie Water Closets aterialbath TubsTo Curb
Showers ToProp. LineLavatories ToExisting
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
'%Vas'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink -Trays To Curb
Dental Units a 3 I't7
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks I Material 6AIV
San Traps TOTAL FEES
Urinals Fixture Fee ,pp
Area Drains Main Drain Fee S
Tater Leaders Storm Drain Fee
Sprinkler Vcdvcs Water Sys. Fee , 0—O
Permit Fee ,0-D
TOTAL TOTAL FEE410,o-U
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final