51087 LOT NO.
NO. STREET
I1XIFOR PLUMBING PERMIT
z a D OF CUPERTINO
i
W
Y o Sanitary No.
0 a Date- L 1 1966M96L(n Permit No
U 1/�{F Prr��pn(TI/.' Pee $
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� A ��io he City of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
aw PP Cupertino, and all other 1 s applicable thereto.
w Use of Premises '
00
, 3 Owner rz Address /0 7-3
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o Address
3 F
CONTILACtOR, AGE
— < Phone �2 `/,yi' — a 7
00 w z / ,Q..,
a .? 3 eL�O Approved', '�J/ 4
Y State License
Ut 1 - PLUMBING INSPECTOR /
I� aBER MAIN 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 J1 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink x Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee a p
Area Drains Main Drain Fee
mater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee O
Permit Fee �0 O
TOTAL TOTAL FEE Alec
RECORD OF INSPECTION
Underground Rough...
Partial Rough_
Rough. Complete..
\4ain Drain
Final...