1681 I/ O LOT NO.
NO. STRGoo �2EET
I ' FOR PLUMBING PERMIT
T
OFCUPERTINO
AUG 3 62 Date �— / 19K-� Permit No. 66
G
CITY OF CUPERTINO Fee $ 17
(O 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.�
P Use of Premises ` � "`-�-�
a i
Owner ,Address
s
By Address
CONTRACTOR, AGENT
Phone O/V�' yApprove!%�j�
PLUMBING INSPECTOR
FIXTURESNUMBER :, r"XIMN
_ ,,DRAIN
I UNITS I FEES=Jjft MMW!.i JUNITS1 FEES
Water Heater
Water Closets
Bath Tubs J -;IIfT,aCiirb�
Showers I I Mmop TO-P M-1i difler-, i
Lavatories 3
Kitchen Sinks
Dish Washers saw, Eg`l
Waste Disposals
Wash Trays 11 STOtLM�j DRAINAGE
Washing Machines Size
Water Softeners Material P.P
Bar Sinks To Main,Drain
Comb. Sink &Traysj I I To Curb '
Dental Units I
Drinkirri; Fountainsl I
Floor Drains WATER SYSTEM
Hoppers I it Size
Restaurant Sinks l I lI Material
Sand-Traps l I Il TOTAL FEES
Urinals I I II Fixture Fee I /A'd; C)
Area Drains l ll MairijPraih Fee 1'
Water Leaders I I 11 stoMpraln Pee
Sprinkler Valves Water Sys. Fee
-
II Peiatjt Fee
TOTAL 1 1Z T(?2A:,!- FEE j 415Va
"5D 25M EC T-
1ION
Partial Rough dKI61,2
Rough implet
Final 2/ z K
Bldg. Dept.
+' Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO /
❑ Sewer Connection Sanitary Permit No. ... 6 3.1.........
E+-15fumbing Final Plutnbing Permit No. -16.j?
Loto. ....r/.......................
f .0
Owner or Tenant ./.. ...... . ... ...... ... .. .. .. .. .. ....... ... ......... - ....
At
.. - ----- -- ------
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Date Connected Connected ---------- ---------... ! -- ----------------------
Date Final ................... --
V
/ PLUMBING INSPECTOR y ?;
ttt 7/61-500 �;: