2124 Ji �6' LOT NO. V✓
NO. STAy�"r
y�Llf I FOR PLUMBING PERMIT
D �y' [ { OF CUPERTINO
Y o U Sanitary No.
0 < Date MAY 2 9 9963 196_ Permit No
w U /�� pp TT ����nn $ T 9
' 0 Aqj onPtet�RER' N'tQCity of.Cupertino for a,pe mit to install plumbing
o < pipes andel or bbxtures listed on the reverse side hereof, and agrees to install said prices
i to and/or 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 �.Q �
3 00
Owner a —� . &./_O .do i Address
_
Z
ffy Address/o +o c,
3 < GONTRACTO ENi
— Phone
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State License G'V 6 71 Approved
PLUMBING INSPEC70R
MBER
UNITS FEES UNITS FEES
Water Heater Site -1474
Water Closets Material G, /
Bath Tubs To Curb
Showers / To Prop. Line
Lavatories To Existing
Kitcren Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposa s
Waslr Trays STORM DRAINAGE?
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
_am . Sink a Trays To Curb
Dental Units
Drinking _
floor Drains WATER SYSTEM
Hoppers Size 9
Restaurant Sinks Material sa
San, raps TOTAL FETES
renals Fixture Fee O
r67rains Main Drain Fee , gd
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 0-0
TOTAL TOTAL TEE06
RECOR F SPECTION
Underground Rough.. /L �✓�
.Partial Rough.. ' L
.Rough Complete..
Hain Drain _
Final... r
2gtyJ L