51075.3 (2) /O j U U �1 , CY—r'—+ LOT NO.
NO. MEET
PPLTCA ON FOR PLUMBING PERMIT
Wii
E� T Til CUPERTINO
r o t V 6 1967 Sanitary No.
3 a Date ll 6 Permit No 'J ' ° 7S
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LL V
� n/� rrpp7� Fee
' 0 Applicationlis herrrebylriadreLtq{tD[[,J 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 rices
> 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 —"�"� '` /`��eL'"'�'
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> 3 Owner 1�T[gS\� Address 11 cuyt Q'7 `APU(C�\"
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CONTRACTOR, AGENT
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State License�3y�(�� Approved
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U PLUMBING INSPECTOR t
N DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavaturies To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste
Disposals-
ash Trays STORM.DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sinks Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rinals Fixture Fee
Tr—e,75—rains Main Drain Fee
Water—Leaders Storm Drain Fee
Sprinkler Valves w Water Sys. Fee
Permit Fee a.J,
TOTAL TOTAL FEE cry
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
.vlain Drain -
Final...