1650 (2) / - "XI I `� , LOT NO.
NO. STREET -
c ® 1 FOR PLUMBING PERMIT
OF CUPERTINO
v
it JU5 2 1 2
Date , 191P- Permit No.
CITY OF CUPERTINO Fee $ %L
Application is hereby made to the`City of Cupertino for apermit to install plumbing
� pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
O and/or fixtures in accordance with the provisions of the Plumbing Code of the Ci' Of
C� Cupertino, and all other laws applicable thereto.
b' Use of Premises at k" J/,
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er�, /\ O G P✓ 5 Address I U Z)'- 1/1 iph> h/!yy
B Ck� Sv�� {1 N Pi' Addres /J E F✓
PNTRACTOR, AGENT
Phone e t� U �J U Approve tD
PLUMBING INSPECTOR
UREMB L — R'
I UNtTs I Fras II Iur9rTsl Fass
Water Henrer � I Size I
ater C osets Material,
Bath Tubs II To Curb I
"Showers I To Prop. Line
Lavatories I II To Existing I I
Kitchen Sinks II Not Conn. y'IL
Dish Washers 1-11 a eox + I
Waste Disposals I 1 II
Wash Trays I I STORM DRAINAGE
Wash n Machines I II Sizc
idlb![Cer bfter2ze Material I I
'Co Main Drain
4 C,'oornb. AirBi 1 rays I I I'o Curb I
rental Units II
Drinking —Fountains—rountainsl I II I
F oot Drains WATER.SYSTEM
Hoppers .: Lize I I--
�Restaurant Sinks Dlaterial ; I I°
Sand—Tr4pij TOTAL" FEES
Urinals I I II Fixture pec I off• t�A"
Area Drains I I If—Main Dr—ain Femme I
Water Leaders I Storm Drain Fee I
Sprinkler Vaives I I II Water Sys. Fee I
Permit Fee
r'TOTAL I I ItnA ,FEE < DO
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final
L