51118 (2) LOT NO.
NO. STREET
LSA, N FOR PLUMBING PERMIT
a MVV �I Y OF CUPERTINO
Y o JUN 17 1966 U Sanitary No.
C " �—/7 d6
0 a Date 196_ Permit No
3 CITY
w 4 G�� RTJRO P Fee $1 v= plumbing
= o
Applicah� is t the City of Cupertino for permit to install lumbin
`o < pipes and/or fixtures listed 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.
LL Use of Premises !/✓//J7/NG �Go�
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o Owner 2lf C—� Address�OSQ�-�it;Ed�LIE
ZJ
z By ��/ � Address {i t'0 Y
O /CONTRACTOR, GCNT
3 ` Phone
oState License Approved
U PLUMBING INSPECTOR
/ V111
Hx I URESNUMBER
UNITS FEES UNITS FEES
Water Heate Size
Wate; Closets Material
Hath 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
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drai s WATER SYSTEM
Hoppers / Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals / Fixture Fee
Area Drains Main Drain Fee
VV/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee CP—
TOTAL TOTAL FEE G Q3s
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final