647 . / / .//.S� �.CC�+W•� LOT NO. !
NO. STREET -
APPLICATION FOR PLUMBING PERMIT(�,,��
CITY OF CUPERTINO
Q . _
Dat 95_ Permit No. /)
' 17 1960 Fee$
AppFEB lication is hereby made to the City of Cupertino for.a permit to install plumbing
pipes and or fixtures,listed. ffg@verse side hereof, and agrees to install said prices
and %c ures In accordan�j%ae provisions of the Plumbing.Code of the City of .
Cupertino, and all other laws applicable thereto.
Use of Premises
:a
Owner--LS ,4 .//i A4 Address_.&/To6f'<C
By/1�n7 S/1 ! l �i Address
/�"� CONTRACTOR+ AG�BNT �+-
Phone ' /+/—��3 Approved
' PLUMBING INSPECTOR
,•-I 1 I 1 I 1 I , 1
FIXTURES NUMBER MAIN DRAIN _
UNITS FEES II UNITS FEES
Water Heater Size L`
Water Closets / /c O II Material
Bath Tubs / I/.0011 To Curb
Showers To Prop. Line
Lavatories / o oII To Existing
Kitchen Sinks .� ��4m Conner /�GJ�
Dish Washers SEWER
Waste Disposals
Wash Trays /,0011 STORM DRAINAGE
Washing Machines Size
Water Softeners - �� Material
Bar SV.lks To Main Drain
Comb,Sink s Trays To Curb �_i
Dental Units II
Drinking Fountains 1 II
Floor-Drainsl 1 II WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals f Fixture Fee ,00
Area Drains Main Drain Fee j /., 00
Water Leaders Storm Drain Fee I
Snrinkier Vanes 11 Water Sys. Fee I
II Permit Fee I /, to b
TOTAL _ TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rougalh Comple e t
Fin "
25-" O