2610 / I LOT NO,
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PLICAT `
IO ,FOR PLUMBING PERMIT
W z ( FEB 2 p 196�C1 202 CUPERTINO
s o Sanitary No..
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I 46/0
0 a Date ..•-L% �r�r nU�Crrr;'196,_ Permit
=u SI No-
Fee $ L o�
W LL i .
O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices -
r
an fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of Premises f.)&lye
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0 3 Owner / l/ ��c�/� � C//1!/� Address-
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afe
J z B `-/r=� ✓ ��� Address
J O y CONTRA OR, AGENT U V V
3 0 PhoneWW
/L/ri✓ Ueeu
o o State License 9� ift Approved
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4'. PLUMBING INSPECTOR
FIXTURES NU, HER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater " Size �f .Co
Water Closets Material LZ
Bath Tubs / /2�?- To Curb ✓
Showers /— To Prop. Line
Lavatories J � To Existing
Kitchen Sinks / Not Conn.
Dish Washers / /.or• Sewer Boxes
Waste Disposals
Wash'Trays STORM DRAINAGE
Washing Machines / — Size
'.eater Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
I:hxx Drains I WATER SYSTEMI
Hoppers Size/'
'Restaurant Sinks Material "I
San Traps TOTAL FEES
Urinals Fixture Fee IY60
Area Drains Main Drain Fee y po
Water Leaders Storm Dns,in Fee
Sprinkler Varves Water Sy . Fee /Oo
Permit Fee Voo
TOTAL. /v ryP= TOTAL FEE ?
RECORD OF INSPECTION
Underground Rough__2X_//
Partial Rough..
.Rough, Complete.. —
\4ain Drain
Final._.