NO PERMIT NUMBER'�1 A-2,21 JI I /- w-,6,, Z 6 LOT NO. /V
NO. STq F.E1'
PTMI FOR PLUMBING PERMIT
z a �� TY CUP ERT IN0
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Q Sanitary No.
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oj Date �(KVM_I 16 Permit No
3 u` e9
w LL �11Tv r.. Fee 5
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Appli I nns h rebylr4,19EtRfl;� i�tt 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
s 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.
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LL Use of Premises
50
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0 3 Owner_ %J /s%-.[iAddress
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� z By (. � 471a”471a" x4/. Address �
CONTRAC R,AGENT
— `m Phone
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atoy State License 2-5 --!Z-- Approved
j q PLUMBING INSPECTOR V,
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PI? R . NUMBER
UNITS FEES UNITS1 FEES
Water Heate Size A E e)
Water Closets � Material
Bath Tubs J. To Curb
Showers / To Prop. Line
Lavatories To Existing
Kitchen Sinks _ Not Conn.
Dish Washers SA er Boxes
Waste Disposals 6 10
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Mate�al /
Bar Sinks To Mai -Driin
Com . Sinks Trays T6—Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /,V It
Restaurant Sinks Material.' ��f, 1 1/��0
San Traps TOTAL FEES
Urinals Fixture Fee
Drains Main Drain Fee S
W3
ter Leaders orm-Drain�oe. �Eap
6prinklor Valves t Water Sys. Fee /, S
Permit Fee �2 n
TOTAL /,_6— ��,5� TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final