5113210422 1 Portal LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Date MarCh'30- �_ �. fii .,:,1,9�9� Permit No.
aryl P F� i ) % i Fee $ 3. 50
Y
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipesrand/.,or fixtures-Misted-on..the, reverse side hereof, and agrees to install said prices
and/6'r fixtures -in accordance *4h"' the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises 10422 Portal
OwnerG • N . Irwin Address 10422 Portal
ByOulligan
CONTRACTOR, AGENT
L't
Phone 736-2000
Address 380 E. Evelyn Sy.
Approve
PLUMBING INSPECTOR
FIXTURES NUMBER
MAIN DRAIN
UNITS I
FEES
I
UNITS
I FEES
Water Heater
Size
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
I
II
To Existing
Kitchen Sinks
Not Coon.
Dish Washers
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
I
I
II Size
Water Softeners
�,$�
�� Material
I
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
I
��
Drinking Fountains
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Drains
Main Draih Fee
Water Leaders
Storm Drain Fee
Sprinkler Valves
I
II Water Sys. Fee
Permit Fee
TOTAL
13, 5 D
TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final