NO PERMIT NUMBER Loa S� �GUi �Y.I'/IA LOT NO. /
NO. STR I.H1
ION FOR PLUMBING PERMIT 74X06'
z Z r I St OF CUPGRTINO
y 0 % Sanitary No.
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° I)atr I N -, 196 Permit No
U Fee $
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LL ° A�flfi3�onrSsnc�4'e'I;y� t ,, TI Ftfi3City of Cupertino for a permit to install plumbing
0 a pipcs•�an�3)or fi�htres hs� on the reverse side hereof, and agrees to install said pnccs
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a Cupertino, and all utli r Iaws.app licable thereto.
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Use of Premises --I lea,-�Lr ete)
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3 Owner Addressaa.�_5J u/A/l:.t� �l'. 1ta [[btu
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z uy Address Irep ��4YItixP/LEe4 ! i
3 CONTRA OA,pAGENT
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ao State License �s� - Approved
U PLU BING INSPECTOR
i,IX I URES \ I —
UNITS FEES UNITS FEES
/WateWater Heate ,� size -Z/—
Water
r Closets Material
bath Tubs �_ To Curb
Showers To Prop. Line
Lavaturies To Existing
Kitchen Sinks oZ Not Conn.
Dish Washers Sewer s Boxes
Waste Disposal3
Wash Trays STORM DRAINAGE
M
Machines Size
fteners Material
s To Main Drain
nk s Trays To Curb
nits Fountainsrains WATER SYSTEM
Size Y4 �v
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders 43torm-Drein-Fee_ :4e.p
�prinklrr Valves Water Sys. Fee
Permit
TOTAL .SC TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final