51099.1 '63 3!� I LOT NO.
J NO. STREET /
APPLICATION FOR PLUMBING PERMIT
CITY) CUEERTIN�j�
nary NoM
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II •,1��
3 a Date /� � , 1W'OV 2 9 PerKit NQI�ZOs9-�
W W Fee $ 3
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Application is hereby made to the1City o Cupertino forla-permit to install plumbing
0 W 1 � 1-,i Y and I
0 a pipes and/or fixtures listed on the-rev'er'se �side heIrcoN, ag1\!reefslto install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other law applicable thereto.
,. Use of Premises
00
oa Owner-//Q � / / Address Sd'w -e-
z By lice(/Pyf U�/ -x P 64 QA-Address � ZCr-421r C
O -�NTRACCOR, AGENT
Sl/
3 m Phone. oy/zs� 7`^3-7�
W Z
ao State Licens��7 / / a Approved
lLPLUMBING INSPECTOR
FIXTURESIN DRAIN
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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee j S
Permit Fee 04, 07
TOTAL TOTAL FEE p
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
-Iain Drain
Final...