51075.1 / a9s3 I X. CLAY4,
LOT No.
NO. STREET
4N171'fd APPLICATION FOR PLUMBING PERMIT
z a
w q+f�TY OF CUPF.RTINO
x = t <J�di' 935�
o Sanitary I o.
LL
o Date — Permit No S/0 7S /
3uA
i w Pees '3-0- 00
° Application is hereby made to the City of Cupertino for a permit to install plumbing
o � pip's a < 1xt t ss li �� R IW
c side hereof, and agrees to install said rices
i ut and/or tx `fres i �ccor'd3tite 'i!N I%ovisions of the Plumbing Code of the City of .
a w Cupertino, and all other laws applicable thereto.
w x
., Use of Premises
o_ o
7N
3 Owner Address
oa
z J �J p�
z By�/y741 '4'Z 51 Cr Address ,�y
° CONTRACTOR, AGENT
3 m Phone , P67 607OF— C A /
w z
w w
ao State License —2 a/�10 — Approved
U� PLUMBING INSPECTOR
X
FIX I URES NUMBER MAIN DRAIN —1
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
is Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Was Ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units —ry-y tII
Drin ing Fountains
Floor Drains $LATER SYSTE
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
�prinkler Valves W _Sys. Fee ao
Permit Fee , JJ
TOTAL .au TOTAL FEE
REC RD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final