2704 ' ?APR
LOT NO. s3�TAPPLICAYIO FOR PLUMBING PERMIT
w.z 1 7 '964C1Y!OP CUPERTINO
�
r o Sanitary No. _.
aLL U
0 < Date � � >°��rn--.,.1196 Permit No
wU I !: r Pee $ ✓�-OD
= LL
O Application is hereby, made to the City of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
w x
LL Use of PremisesS/oF ieE
00
oa Owner z[iOT Address/SGS C(//f/ffiEST f
zJ
z By I�F rlC. Address,��n /S� .SfJ/lG7Tflf7
3 P CON'rAACTOA,AG{n 1
— ua Phone X96—•-�9�-3'
w z
w w
¢ a
0 s State License Approved
a o
—U
PLUMBING INSPECTOR
FIXTURES -NUMBER IDRAIN
UNITS FEES UNITS FEES
Waicr Heater Size
Wate; Closets Matcr.'v
Batii Tubs 1,06 To Curb
Showers / 1,96 To Prop. Line
Lavatories 0 To Existing
Kitchen Sinks ,U� Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines ,06 Size
'seater Softeners Material
Bar Sinks To Main Drain
Co;nb. .Sink % Trays To Curb
Dental.Units
Drinking Fountains
Plonr Drains WATER SYSTEM I
Hoppers Size / " �U
Restaurant Sinks Materi Q U.
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee 11,00
\hater Leaders Storm Drain Fee
�prinklcr Naives Water Sys. Fee ,req
Permit Fee a,00
TOTAL TOTAL FEE le,
RECORD INSPEqjQN
I
Underground Rough..,5"/, —
.Partial Ron
gh.. 5'-
.Rough. Complete.. �'
'Iain Drain /,5�.
Final... j
L 44--11