51132 (4) I&V >,a � aTNO.
NO. Sn E.E.T
�rATION FOR PLUMBING PERMIT
.z i 1VV�� q4,Y OF CUP17RTINO
r o D Sanitary No.
•
0
0a Date �96� Permit No S l//i Z
Pee 5
0 ti hg9�y City of Cupertino for a permit to install plumbing
o pipet a /orMixtult54 t l everse side hereof, and agrees to install said prices
> 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.
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Use of Premises
00
3 Owner Address /6 3` I d 62'7-' ..0
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zBy 66=9dX111 Address
O CONTRACTOR, AGENT
3 � �
— < Phone �Y`f— 7 J S O
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0a cssirot�
a o State License 9 Approve
Y I PLUMBING INSPECIO
HX I URES1BER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heate Size
Water Closets Material
Nath 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 Drains WATER SYSTEM
Hoppers0103Size
Restaurant Sinks Material
Sand Trap /y TOTAL FEES
Urinals AV4 Fixture Fee .yL
Area Dbains A Main Drain Fee
��/ate rp Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee Z IM
TOTAL TOTAL FEE 7 06
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final I