1797 LOT NO.
® IC . TI FOR PLUMBING PERMIT
?SEP 201962 OF CUPERTINO -
Date SQ/PT 90 195 Permit No. /7y';7
CITY OF CUPERTINO Fee $
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.
USe of Premises
:'a
;� Ownen �� dress
Byc/O�ilt�n Address
CONTRACTOR, AGENT
Phone Approve
PLUMBING INSPECTOR
FIXTURES I NUMBER MAIN DRAIN
I UNITS I FEES 1 UNITSI FEES
Water Heater $i2e
Water Closets 7 �� MaterialC,�
Bath Tubs / To Curb
Showers To Prop. Line
Lavatories To Exist'
Kitchen Sinks No Conn
Dish Washers I SEW BOAS
-Waste Disposals
-Wash' Trays STORM DRAINAGE
Washing Machines I Size
Water Softeners I Material
Bar Sinks-. "I To Main Drain
Comb. Sink s Traysl To Curb I
Dental Units —�
Df inki ng,Fountains II
Floor Drains I I II WATER SYSTEM
Hoppers Size I'i
Restaurant Sinks Dlateria
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Spri klcr Naives I I Water Sys. Fee I &0
i v sJ. t.r1 Permit Fee Qz crt)
TOTAL TOTAL FEE 1 -1- 06
RE OR OF PE ION
Partial Rough
Rough Complete
Final
`..Bldg. Dept.
''t-�;;• Office copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer'Connection .y `^ Sanitary Permit No.
,: /Q..L. :......
}, [14/I1fumbing Final Plumbing Permit N0. ...,1. � f
Lo No. ........:.....
Owner or Tenant
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UMBING INSPECTOR
All 7/61-500