1965 /0.23/ I j0 X/i r /J z fl 4 LOT NO. 71::Z2
NO. STREET
APRtTly R PLUMBING PERMIT
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w z -CUPERTINO
, a e c Sanitary No.
3 a Date FEB 2 6 996319 _ Permit No. 19 6 C
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o ° P pplicelle e 'It
e"RER iWQf Cupertino for a permit to install plumbing
a < i s and/W.,tthurreSs it�sted�o_n the reverse de hereof, and agrees to install said prices
i a
an fixtures in accordance with the ovl 'ons of the Plumbing C e of the City of
¢ w Cupertino, and all other ws a li e t eto.
w I �
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a Use of Premi s
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N `NO 3 Ownev Address
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Z JZVjZO B04 Less /
3 F CONTRACTOR,A
— 0 Phan
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am State icens _Approved T .0 Q/—
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sa`J PLUMBING INSPECTOR
NUMBER, 11 :MAIIN
UNITS I FEES li j'.UNITS I FEES,
Wirer Heater Size
Water Closets Material
-ffath—Tubs -- To Curb
Showers To Prop Line
Lavatories To Existing
K 7tcFPen—Sinks Not Conn.
'Dish Washers Sewer Boxes
Waste—Disposals
\d-4sh—Trays STORM DRAINAGE
Size
'Wiler Softeners Material
ftar--Sink s —lo Main Drain
ToCurb�mn7k,—&-Trays
rDnhn m
Floor Drains WATER<SYSTEM
H opper Size
.Rcitaur,i�nt Sinks
Material
TUFAL FhLb
SanT7,7p—s
U—nnals Fixture Fee 1
�reaDram�s —/
Main Drain i Fee
Water Leaders I —Storm Drain Fee
Sprinkler Vuivcsate $
'Fee
P c r m i t r�lec'—
4 TOTAL TOT-AL FEE
RECORD OF INSPECTION ,
Underground Rough...
R;:Partial, Ru oomplL c i e..
Main Drain
Final...