51087 (2) �2,)— O / I✓v'i� LOT NO.
NO. STREET
TI ; N OR PLUMBING PERMIT
a11OP CUPERTINO
wz ?M1AY
° 1 �9 Sanitary No.
Date 196 Permit No
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U i
° APPIDU
`p� }'�H�tbI' Clf Fee i to
A 1 Abd is reb y 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
i w Cupertino, and all other I applicable thereto.
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0 Use of Pr ises A MR1Z l
0 3 Owner Address r1
oa
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J zBy.- u'Q Address
° CONTRACTOR, AG
3 G-1 arlL d
— 0 Phone
f State License Approved ""'
a o
U PLUMBING INSPECTOR
I) RIN
UNITS FEES UNITS FEES
"Vater Heate Size
'X'ater Closes
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 a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ( -00
9rea Drains Main Drain Fee
W ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee I
Permit Fee ' .Ov
TOTAL q,00 TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...