51126 22379 I a,
OT NO.
NO. - MEET
® f�� T�C ON FOR PLUMBING PERMIT
V ���`i .ITY OF CUPF.RTINO
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' 0 �� 10 196f Sanitary No.
LL
° � Date 196 Permit No��/��-�
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w LL (�� (�� �pC� Fee $ .1(D,
° CTA pl ion o the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of tileCity of
a Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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3 Owner L , Address / 6� es
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By ZLl�T , � 4Vl
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3 CONTA OR, AGENT
— m Phone 179. -�5.�•
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c o Stare Licence Approved
U PLUMBING SPECCOA
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FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNIT51 FEES
Water Heate ,3 _i,cc Size
Water Closets (p 6,0f) Material
0.4
bath Tubs 9.CQ To Cu
Showers / j. ee To Prop. Line
Lavatories S',(,nL To Existing
Kitchen Sinks '3 _j 00 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines / /, OU Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin „ rays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
oft peers Size
Restaurant Sinks ' Material
an raps TOTAL FEES
rina s Fixture Fee 9/ 00
rea rains Main Drain Fee a,610
Vater��Leaders Storm Drain Fee
Sprinkler Vdvee Water Sys. Fee .CL
Permit Fee „/.p O
TOTAL TOTALFEE 7-6.—p
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final