51087 (2) LOT NO.
zi VDEC
PPL'IOA IFOR PLUMBING PERMIT
21 1965 � OF CUPERTINO
' X Sanitary No. r'7
LL V /
Y X
C
3 U Date � ?' y� �J�96� Permit No .S[ �
w U Fee $
2 LL
o Application is hereby made to the 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
>
and 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
r S
0 w Use of Premises
00
oa Owner //'� fr Address
� = B Address
o y N7
SS
W Phone L, 2 083
ui State License e-t�J )�07 Approved
a u� Ef ' rl I4asVif°ibx ✓A�
FIXI URESNUMBER I R IN
ems. UNITS FEES UNITSI FEES
Water Heater Size
Water Closets Mates;
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 -
hilater Softeners - Material
Bar Sinks To Main Drain
Comb. Sink w Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
#opperr-- Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /
Area Drains Main Drain Fee
Vater Leaders Storm Drain Fee
,p rinklcr v;�ives Water Sys. Fee
Permit Fee -3
TOTAL TOTAL FEE &a—
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
\'Iain Drain
Final...