NO PERMIT NUMBER (5) LOT NO.
NO. SIREP.T
47
APPLICATION FOR PLUMBING PERMIT
CITY ON CUPERTINO
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x Sanitary No.
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0 /Pj!rfFY 1961 Permit No
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w Pee $ d9
phc eP�, jj�a�de to the City of Cupertino for a Permit to install Plumbing
0Q pip s am b llis i on the reverse side hereof, and agrees to install said prices
I 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./ N�
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Use of Premisesv d, a0 S� �ttt/ 104" .
00 2
3
Owner L Qi rr) Addresses✓'�S /��✓ (�
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, By ZU Of :�Lt /`'�f 4� Address
C/ONTAACYOR, AGENT
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02 State License /s�a- Approved
PLUMBING INSPECTOR
I'IXTURES NUMBER MAIN D AIN
UNITS FEES UNITS FEES
Water Heate Size k4u
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavaturies To Existing �-
Kitchen Sinks Not Conn.
is Washers Sewer Boxes
Waste Disposals
aih Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks rays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATERS EM
Hoppers ize y
Restaurant Sinks Material(,AL
an raps TOTAL FEES
Urinals Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
Jptwkler val�cs Water Sys. Fee /, 0-0
Permit Fee , g..p
TOTAL TOTAL FEE a 00
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final