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LOT NO.
NO. STREET
N ` Cny or cur�aWPLICATION FOR PLUMBING PERMIT
Z 4 CITY OF'CUPERTINO
' 0 N%AR 171971 Sanitary Nn.
3a Date I9J L Permit No �54
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' 0 Application is hereby made to the City of Cupertino for a permit to install plumbing
°o a pipes and/or fixtures Iisted on the reverse side hereof, and agrees to install said prices
i N and fixtures in accordance with the provisions of the Plumbing Code of the Clty of
a w Cupertino, and all other laws applicable thereto.
W =n
J LL Use of Premises 2 E.S
O_ O
o Q' Owner T"7CHEK hRi['i Address S h^67
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J $ !F' /✓L/jG S't-ayIC �: Address.3SG PP/IRN/'rOvT
oy
- CO-fficTOR,AGENT
0 Phone 2 5 7 FY 117
W
o
U PLUMBIte License 2 3 Z 408 Approved 7—
NG INSPECCOR
FIXTURES NUMBER MAIN DRAIN
Units Fees ' Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop.Line
Lavatories Existing
Conn.Kitchen Sink Not
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
WasWng Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water er Stomi Drain Fee
Sprinkler System Water Sys.Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee 3, c
CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE
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Job Located at ----- -
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You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the inspector.
252-4505 Date: .... ........ - --------- ...........
City Telephone Inspector: .. — .. ..------------ -------
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