51028 LOT NO.
NO. STNEF
N a a M11 TPI OR PLUMBING PERMIT
z _ e Y CUiPERTINO
z
x 'e 7 'IVhgY _ Sanitary No.
o Date 6 6 1956 ' Permit No .S—/O c2
3 a
U CI Pee $
10
� Application is ereb} l� ii y of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the rcV, ,se side thereof, and agrees to install said prices
1- 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.
aLL Use of Premises
00
N
3 Owner!Rr o Address 0 6 7 C/l," e .
0
0a 1y
Z J
Of-
* , By Address
0 y CON CTOA, AGENT p.
3 0 yasi (�✓j i,
– Phone 77-1— O O '^
W
Qa (2, S.3 / q0 (7 4/
a o Slate License / ,� Approved itLy<—�
U PLUMBING INSPECTOR �,
FIXTURES ;
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Va-s'T Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink-& Trays To Curb
Dental Units
Drinking Fo tains
Floor Drai c ti WATER SYSTEM
Hoppers ,j- C-Z Size
Restaurant Sinks Material
San Traps' a(h . cg TOTAL FEES
Urinals Fixture Fee
Area Drains / c� Main Drain Fee
eater Leaders - Storm Drain Fee
sprinkler Valves Water Sys. Fee
Permit Fee a
TOTAL TOTAL FEE ?
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final