51179 (2)100 / 9 �C7/ //0`4 /d A- LOT NO
NO. STREET
1NMR. PLUMBING PERMIT
wc YUPF:RTINO
Sanitar No.
3<Date °8I Permit No 'Ll—//
U �. (� (/��II CCppm� pp Fee y�
nW App, ion is Hereby htS�ePtnf6flhlQ:IOof Cupertino for a permit to install alplumbing
O < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
aw Cupertino, and all other laws applicable thereto.
00 Use of Premises .1 rrl/2
oa Owner C /�% i 1 %C CCl-W6 6C Address_ "e �—L
d Address 71 E Cr4Qrc &W
CONTRACTOR,ENT
3 }S7s 9s �%
— m Phone pc
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W W W;LLIAM D. EENEVICH
W
o State License / �� V Approved
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YI PLUMBING INSPECTOR
FEES
Hoppers
Size
Restaurant Sinks
Material
San Traps
TOTAL FEES
rinalls
Fixture Fee'
rea Drains
Main Drain Fee
WUater Leaders
Storm Drain Fee
Sprinkler V31ves
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
\Main Drain