100051 LOT NO..
NO. STREE.t'
A--`P TION FOR PLUMBING PERMIT
zD CITY OF CUPFRTINO
,ISEP 1 Sanitary No. ..
o llate 196 Permit No v S�
3a
UFee 5 3.e�-t�
w�ITY A scat s dQ QUP �4,Q
� e to the Cit}' of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
w2 �7
a Use of Premises,
00
7 N
r 3 Owner ^ Address - O'sd'_—✓?J
By AddresaL 5 / CQ
3 0 CO�yN7/RACTO/R, ENT
— 0 Phone Q (� C� >5
w z J
a o State License crC Approved j
U� PLUMBING INSPECTOR I'll
-I UREN NUMBER MAIN DRAIN
I.
UNITS �FE�E�S UNITS FEES
Water Hcate / & ` Size
Water Closets Material
}lath 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
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Moor Drains FFixtureF
SYSTEM
Hoppers
Restaurant Sinks
San Traps OTAL FEES
Urinals eeArea Drains ain PeeZY`ater Leaders rain FeeSprinkler Valves s. Feeee TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final