2137 �" fyp J���`� I• C�/%.P els o���r�✓ �, 'LOT No. Z
No. �• STREET
APPLICATIONJOR PLUMBING PERMIT
Z . J CITY OP CUPERTINO
x o .i a �.,f/ Sanitary_No..
° Date GyJ 196 Permit No
3 a jjR� Od
U
Pee $
,1 •!' ° Application is hereby made to the City of Cupertino for a permit to install plumbing
W.
0 .pipes and/or fixtures listed on the reverse side hereof, and.agrees to install said prices
i N and/or fixtures in accordance with the provisions of the?Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
,w x •i" 3. w ..
w74 .
use.o_ Premises 77e `h� a Y,r •'
f' O 0
eaOwnEhp,� Address
J
z By ?E s Ao /yX",1A Ze,& Address
0 CONTRACTOR,AGENT Op
. 3r
— a . Phone_ 7,""
State Licens U - Approved
PLUMBING INSPECTOR `
7177=9-- NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Vater Heater /
Size
seater Closets 11Material
ath:pubs..aZ To Curb
howets' 1) To Prop. Line
Lavatori',s To Existing
Itchen tSinks Z Not Conn.
Dish Washers Sewer Boxes
Waste Disposals Z
`Nash Trays STORM DRAINAGE
Gashing Machines I Size
IGater Shfteners Material
'Bar Sinks .To Main Drain
�omb.-Sink , Trays To Curb
Dent.il Units
Drinking Fountains
I'bors Drains WATER SYSTEM
Hoppers Wei,Restaurant Snks SanTTAL FEESUrinals eooArea Drains n Fee ��aterLeders in Feeiprinklcr Valves Fee / Oo oa
TOTAL1 14K TOTAL FEE ea
RECORD OF INSPECTION
Underground Rough. 3
Partial Rough..
Rough. Complete_
\lain Drain ��3
Final...