100005 Plumbing PermitLOT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
y �Sanitary No.
ij Sa
Date ��' ��7 196" Permit No 100,OOs
Fee $ 7 00
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicaal/l�le thereto.
Use of Premises �l�'.� GLC �[✓
AGENT
Wne.C`7 !o — S \S I `f
State Licenser L/ 4 / O
!Address-? 60 0 /��P2? [ Q T
Address �� r'�/uCC-/'r�7.�c- �Lfli.
Approved
PLUMBING INSPECTOR
FEES
Urinals
Fixture Fee
140-
I,
Area Drains
Main Drain Fee
-' BU
Water Leaders
Storm Drain Fee
Sprinkler Volvcs
Water Sys. Fee
op
Permit Fee
p p
TOTAL I 1 11 TOTAL FEE 7, m O
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Alain Drain
Final...