NO PERMIT NUMBER laS36 f 04T/} L OT �
NO.
NO. STR F.F.I'
AARP KATION ,FOR PLUMBING PERMIT
. Z ,
'W Z 7,�' FitTY OO CUPFRTINO
x a 1 VOV 22 1966n / Sanitary No.LL
0 < Oateb'U Permit No
w CITY c� /� p[p ree $ 63—
O Application! is hcreb}PTIU c4RT'!vPtj }, 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
d/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Z w Cupertino, and all other laws applicable thereto.
a Use of Premises ��� l h �� 0O L
00 / _
1 3 ` Owner-.' � /!7 on. rr}.e-� Address ���p�C� �d��+
oz ���-�Lr�/�yLr �'OOC. Address 0, �LC_/9- A6
J O y CONTRACTOR, AGENTILI
/3- `0 Phone
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State License` �� ` f� Approve
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PLUMBING INSPECTOR
H. I URFS NUMBER MAIN DRAIN
I , UNITS FEES UNITS FEES
Water Hcatc I Size
Water Closets 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
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
OA
Hoppers ' Pai Size
Restaurant Sinks Material
San raW.� /rI TOTAL FEES
Urinals Fixture Fee
Area Drain /d.� I Main Drain Fee
WaterLeaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee 3�?
Permit Fee 'Lcra-
TOTAL AI9 TOTAL FEE 5-V
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final