2440 NO. EF. LOT NO.
LtSEP. RPLUMBING PERMIT
IOF 'Fl"lNO
xo2963 3i Sanitary No. _
0 � �/�° Dt196- Permit No ,�11�� v
3� CIT OF CUPERTINO Fee S6
W LL
= o
� Application is hereby made to the City of Cupertino for a permit to install plumbing
°o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i a and/or fixtures in acc rdance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all her—laws applicabllee h eto.
Use of Premises X
00 d f.
3 Owner Q /� ' �/a-�- w�_ Ad ress 0/ U- %L' rLf�L.
JO y ,J CONTkACT AGENT /1 Address
3 m Phon )� "O I/ 7 R
s, V
W z v
uY
a 0 State Licenses-:* K3 y Approved c
s� PLUMBING INSPECTOR
__rT' RES NUbfBER ji MAIN DRAIN
UNITS FEES UNITS1 FEES
Water H-ater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line a
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE '
Washing Machines Size
' ater Softeners Mate
ial r.
Bar.$�ks-- ' To Main Drain
Comb. Sink a Tr a To Curb 1
Dental ruts
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
SiGd Traps TOTAL FEES
Urinjls Fixture
Area Drains Main Drain Fee f
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee .tl
Permit Fee ') .00'
TOTAL / .1 TOTAL REE 54' ®. Cl
RECORD OF INSPECTION
Underground Rout...
.Partial Rough..
.Rough. Complete_
\Iain Drai
Final__.