1306 NO. SBET
Az LOT NO. 3
I TION FOR PLUMBING PERMIT ^ '\\
p� CITY OF CUPERTINO ( z Z Z p
d sit Dt'
195 Permit No.
�P CIT QE�RTIfO Fee $—/el-
ere
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^f1 pl ion ere y ma a 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 others laws applicable thereto.
Use of Premises �t �Qit Cl21u
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Own Address "
L Address i ! ' c
CONTRACTOR, AGE T `
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one
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Approve /
PLUMBING INSPE OR
�I F—URES NUMBER MAIN,JDRAIN
I UNITS FEES UNITSI FEES
Water Hegler I Size,
Water Clcsets Material - _
Bath Tubs To Curb ay,
Showers ToI?gop. Lineyjfj
Lavatories Y To,Existing
Kitchen Sinks / 11 No(Con 0
Dish Washers BEW17 BOXEfg I!
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size -^ -�
Water Softeners �� Material
Bar Sinks To Main rain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains 1 11
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks JJ Material,�,(�,,
Sand Traps TOT Sf IFEES.
Urinals Fixture Fee`-. 3.�
Area Drains 11 Main rDraih Fee If
Water Leaders StormyDrain Fee
Sprinkler Valves I I Water";Sys. Fee I [,
Permit`rFee /-
TOTAL I 11 TOTA-L% FEE
RE ORD F S TION
Partial R�,igh
Ra— * trip etc
Final`
•,ys
Cupertino Sanitary
OffiC6.I
O:Opy
BUILDING INSPECTOR'S OFFICE
CITY 01" CUPERTINO
F1 Sewer Connection San' Permit No. -ire
19---.
........
Sanitary
Plumbing
Plumbing Final mbig Permit No. ................
t No.�,:?/
Owner or Tenant .......
4.. ...........
At
......................._...._------
Tract
.............. ...... ------Tract ................
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Date Connected -. .....-..-.....' /)/°7---------
Date Final ------- Z-
----------------- ....... -------- 19..........
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PLUMBING INSPECTOR
iti i/6o-m-