NO PERMIT NUMBER (2) W(f 2 I eoc U M Ras eve LOT NO.
NO. STREE.I'
APPLICATION FOR PLUMBING PERMIT
N a
3Z-4 tRiKOP CUPGRTINO
r 0 I Sanitary No.
Q LL
3 Date IYI- 19 {, Permit No
a r
u 1
w LL Pee $ 3. y
xo
Application is hereby made to the City of Cupertino for a permit to install plumbing
0 pipes ands Ture's)listetPbjilttr ��vverscc��side hereof, and agrees to install said prices
i I and/or fixtures in iccbrdarfc�'w�th�theipr*isions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x ,
� r
a Use of Premises 1 4AJELL/.Oe
00
r 3 Owner__P�— /94//1 Address .Z�y Z COL u'M,/su l #1604,
oa
zJ
o By c�1QV/SOF`- OK- SAq"TCAddress 9VS L/NCOLN AJF�
CONTRACTOR,AGENT
3 �
— 0 Phone ,2930/79
w z
aa y- iyo3 Approved
a o State License
PLUMBING INSPECTOR
FIXTURES J BER
UNITS FEES UN[TS1 FEES
Water Heim Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners � Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks t Material
San Traps TOTAL FEES
Urinals t Fixture Fee ZJ O
Area Drains Main Drain Fee
/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee p
TOTAL TOTAL FEE S. O
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complett
Main Drain
Final