NO PERMIT NUMBER as� �61 A�I&X 6 7� w LOT NO.
NO. STREET
® QFPi11Cv4TON FOR PLUMBING PERMIT
OF CUPERTINO
zz
s 0 S II'!In' SanitaryNo.
0 o Date � A� ) 1956 Af,A 6 Permit No
Fee
0 Ak1'��/ $ � ._
1i Yo,0Fhehe City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed"dri'�f4�l�verse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
w Use of Premises00
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f' da3�' �icC
r 3 Owner �pyYyO-Crm- Address
Z By �J O( �f�G/ Address �9�LFnmll��c4LQ,
3 0 CO RA OR, AGENTr
w z
w w
u s State License Approved
co
U PLUMBING INSPECTOR
41
733�'
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate .017 Size t',1
Water Closets 3,00 Material
Bath Tubs a Q[7 To Curb
Showers / 00 To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks p`; a, Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing-Machines Size Size Q
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink m Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 1:5 0
TAre—a Drains Main Drain Fee , O
Water Leaders Storm Drain Fee
-prinklcr Volvos Water Sys. Fee A,
Permit Fee• of. 0 O
TOTAL TOTAL FEE p• p-�J
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...