51001.3U3e, 3 I ze L- S T LOT NO.
NO. STREET' -
APPLICATION FOR PLUMBING PERMIT
z z t j � E <PLY O'�CUPERTINO
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Sanitary No. S �L 040x° UG 11967 Y
0 a Date G / 195 Permit No. 100 �•
o r.1TV �� ""REP Fee $ --746, F 0
Application is h reby made t the City of Cupertino for a permit to install plumbing
'o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other Taws applicable thereto.
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Use of Premises �.LQ
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o < AddressXr.
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,By �'�'�CC� _ l�m�-c.r� (/._.ltc.._.A--+ Address'/SX
O CONTRACTOR,AGENT
3 u`, Phone
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f State License y Approved':.: _.. ._ .._. • "�
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— U� PLUMBING INSPECTOR ✓
rea
ler Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final
UNITS
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U%P3�a 3 104114 J7'
NO. STREEI
LOT
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
A Sanitary No.
DateT,J
6— Permit No
UL 29 1970 Fee$ zo 7
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixturesMt {�71lI I erse side hereof, and agrees to install said prices
and/ provisions provisions of the Plumbing Code of the City of
Cupertr , and -all other laws applicable thereto. 1
Use of Premises �7.U�l.V/ L. C, -as -,w s �e 2zz:/
State License. ��O`382- Approved
PLUMBING INSPECTOR V
Water
Washing Machine i 1 11 Size I
Water Softeners Material
Dental
Total
To Curb
WATER SYST,
Size
Material
TOTALF
Fixture Fee
Main Drain Fee
.7 Storm Drain Ft
Water Sys. Fee