1758 ✓ � ��/ I v - LOT NO.
NO. STREET
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PLUMBING PERMIT
Y OF CUPERTINO
UG 2 1 /
Date , 197fla/ Permit No. Z7,58
CITY WERTINO Fee $ —
i' Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Y Use of Premises
a'
N Owner Address
J gypsewl SOFT uvat • ccwvlrn ".*, Addres,
CONTRACTOR, AGENT '
PhoneW40 tonygl�nr ~�� � Approve
T PLUMBING INSPECTOR
SURES NUMBER MAIN DRAIN
UNITS I FEES IUNITS 1IFEES
Water Heater i $i2e
Water Closets �� Material
Bath,Tubs To Curb
Showers To Prop. Line
Lavatories To Existing 1 ,
Kitchen Sinks Not Conn.
Dish Washers SEWER BOXES
Waste Disposals
Wash Trays �� , STORM DRAINAGE'
Washing Machines Size". I3
Water Softener Material
To Main Drain
_ Trays �� To Curb
its —
'Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers _; �� Size
Restaurant Sinks .IL,.yr,' �� Material
Sand Traps I '; 11 NOTAL FEES
Urinals �.," �� Fixture Fee ,\
Area Drains Main Draih Fee
Water Leaders ;Storm Drain Fee
Sprinkler Vawes Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 2
RECORD OF INSPECTION
Partial Rough
Rough Com let ?
Final "/ s S n
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