NO PERMIT NUMBER (2) I\ ��B �' LOT NO. ��
NO. STREET
&PPXicATION,FOR PLUMBING PERMIT
d + ) 1 r� F-`le_kknlY)OF CUP ERT IN0
f o I Sanitary No.
r 4 (� C 1957 i
o Date - � � — / (96`� Permit No
3a
W •-\/ nr- Oil cg 'Nin Fee
$
1- O App cation is.herel;r made.to the City 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.
w x
LL Use of Premises
o
3 Owner 6A4 16111,10 Address
oa
ZJ
� z By Address
CONTRACTOR, AGENT
3 �
- mPhone S ?��477
W w ���93>/
WILLIAM D. L'ENEVICH
a o State License Approved
_,L PLUMBING INSPECTOR j/
FIX,I URESNUMBER
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material 61,
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
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material /
Sand Traps TOTAL FEES
Urinals Fixture Fee'
rea Drains Main Drain Fee pa
Water Leaders -S Fee J-o
7-prinklcr Volvcs Water Sys. Fee SV
Permit Fee V e>
TOTAL / TOTALFEE a6. 5-0
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...