1502 LOT
LOZ NO
NO. STREET
® c R PLUMBING PERMIT
I F CUPERTINO
�b+ APR 1 62
Date Permit No.
a
Fee
CITY OF CUPERTINO
n 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
V Cupertino, and all other laws applicable thereto.
B Use of Premises AE-f/Orn/,-c'
u
� rn
Owner e &Aeo n"a P/10 Avg T/yr Address---C//.°/-q j'/M O
By r! v v n v Address
coNc`roa, AGENT
. f �� Phone �r-k// Appy PLUMBING INSPECTOR
71)ZT13t_
-1 UNITS I FEES it JUNITSJ"FEES
iv.ter Heater I ) 1 11 Size il,0 7
W& Closets ;L Material c
�j$a�h Tubs
tl j To (_url)
_Zh6wers I To Prop. Line./I I
avgori To Existing
NVn,
Sir o Co
'Dish Washers
!Taste Disposals I
Wash Trays S-fORM DRAINAGE
WaM.',Iing Machines size
W tter Softeners I Material
Bar S,inks' I, ro Main Df ain
"Zink &Trays To Curb
Dental Units-
D,,irikiL8 ounnain,j
tj i�
r
.10or 6,a'; WATER SYSTEM
,Hoppers Size
, 0estaqrant Sinks Mat
erial IhA V
'Sand raps TOTAL FEES
Fixture Fee /1,I)o
F=Ae,T�rains Main Drain Fee
r,V4te,-Leaders Storm Drain Pee
ter Vtves Water Sy . Fee7
gT OT, Permit Fee );o
TQ)TAL.,Fhh lif, o
JR CORD OF INSPECTION
J..Paffial Rough4o;F,./2,,C,��
[,Rough Compler
A&
rN
inal
i
r."K
i:N
CA
) M ,