2393 /Y / 7/ LOT NO.
NO. STREP.I'
�A�PPLvI,C,WTIOt1 FOR PLUMBING PERMIT
z ? G� `�' C �OP CUPERTINO
R
s' o / � .�. Sanitary No.
o Date1963
!U 196 Permit No
Fee
' 0 A C6li#�jn s0{iereCylWa&R fhel�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
> < and/or fixtures in accordance withlthe provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws Applicable thereto.
v
LL Use of Premis s
0 0 �t �y�j�/ p /
a a Owner , !'V�lD Address 2&0¢1! P IA& tti'/A!Z6
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J o D� A ukro�4R Address
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< Phone/ - -' - / -- -
L Q o, State License Approved��� L I
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IUT� PLUMBING INSPECTOR
L 1
FIXTURES NUIN'IBER MAIN
UNITS FEES UNITS FEES
Water Heater Size
_Water Closets Matera_
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers . Sewer.Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Wshing Machines Size
'.Hater Softeners UO Material
Bar Sinks To Main Drain
_Comb. Sink s Trays To Curb
Dental Units— "
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size '
Restaurant. Sinks Material
raps TOTAL FEES
Urinals! Fixture Fee
Area Drains Main Drain Fee
\)Vater Leaders - Storm Drain Fee
Sprinkler.Vmves Water Sys. Fee -7df
Permit 'Fee OO
TOTAL TOTAL FEE
'RECORD OF INSPECTION
Underground Rough...
.Partial Rough.. .-
.Rough. Complete..
.Main Drain
Final...