100080 aooBSl ���as lo��i� 8cv� LOTNO.
NO. STREET
D IF-OR
PLUMBING PERMIT
< OF.CUPERTINO
r o R 3 1966
Sanitary No.
O a Date /a 196 Permit No lot h ro�
3 U fp
= LL QF PERTINQ Fee s
0 d�h ati is h%y made tot e 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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
Use of PremisesEti
00
> N
, 3 Owner E.LEA/ ,PAS' Address.�C�/�BC�.�fFi�.v/_t LPt,E .�.cdv
0 <
ZJ
Z By���/i�q� �t�Ur �a Address 44-'Z/ OUPXEALC (n1 Say]-Lrf
3 O CONTRACTOR,AGENT '
— 0 Phone -9 9f
ao State License 7�7 Approved
U �� PLUMBING INSPECTOR
-E MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcatcr Size
Water Material
Bath Tubs To Cur
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
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
I` oor Drains WATER SYSTEM,
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee .O 0
Water Leaders Storm Drain Fee
Sprinkler Voivcs Water Sys. Fee
Permit Fee Q-00
TOTAL TOTAL FEE O0
RECORD OF INSPECTION
Underground Rough...
.Partial Rough_.
.Rough. Complete..
\Iain Drain
Final...