2351 �A .. .. LOT NO. : 7
NO. STREET
PPON FOR PLUMBING PERMIT
< C[TY OF CUPERTINO
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IF
A . 1 963 Sanitary No. �7 /
0 a Date 1061 Permit No �"•��!
3 o CITE' CUfRT11�0 Fees_
n w pp tion is er y made to the City of Cupertino for a permit to install plumbing
0 a 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 m Cupertino, and all other laws applicable thereto.
Use of Premises
00 T/
3 Owner;%e' '*-f Address
z z sy ArT 14Ile y' Address 'let- �vX `SLY
3 � CONTRACTOR AGENT
— m Phone
ao State Licensr &;' `6 . 4F Approve C. 0
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PLUMBING INSPECTOR
PISUMBER
UNITS FEES UNITS FEES
water nearer
pNot
,UC
ater Closets ,00l 2 _
3ath Tubs d QToes
i1 wers / ,6 0p. Line
avatories 0 0ting
Citchen Sildrs 0 Unn.
ish Washers Sewer Boxes
T,hsre Disposals
I asV sh Trays 6 p STORM DRAINAGE
Washing Machines x -CCI Size
�\/nter Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
rinks Ing Fo,.tpns
oor Drains WATER SYSTEM _
Rol�puraers Size J
es'tant Sinks Material Ty
aif raps TOAL FEES
rinals Fixture Fee , D
tea Drains Main Drain Fee �-
Water Leaders Storm Drain Fee
Hprinkler Valves Water Sys. Fee
Permit Fee
TOTAL p C,C, TOTAL FEE
RECORD OF INSPECTION
Underground R.ough,..
,Partial Rough..
Rough. Complete.. —
\$ain Drain
Final... I z