51027.7 (10) r, 9n � �.
LOT NO.
h0. STREET
AULIC FOR PLUMBING PERMIT
z p CITY Of
CUPERTINO
z j
I o +COanitary No.
rc a
o a �l at/e Q 196— Permit No EZDe? 7 1
3 U Fee $ � , ad
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Ip1 oryy�j�G {r� e�to the City of Cupertino for a permit to install plumbing
o a C�� a or 16�(tl}P sIc;J�i� the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Pring Code of ,le City of
a w Cupertino, and all the laws plicable thereto
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0 LL Use of Premises
00 �!
3 Owner Address
Address
az By / /�ep� �/�... /IA /l /Ye co„�`I'Qddress 7fic 4
3 CONTRACTOR, AGENT r
PhoneWW
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ao State License,97�� Approved
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rQ/ PLUMBING INSPECTOR
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FIXTURES N UNI BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate $iZe
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Si Not Conn.
Dish Washers Sewer Boxes
jDri,nkingFountains
e Disposals
s
Trays STORM DRAINAGE
ing Machines Size
r Softeners Material
inks To Main Drain
. Sink s Trays To Curb
al Units
ing Fountains Drains WATER SYSTEM
ers Size
urant Sinks Material
raps TOTAL FEES
als Fixture Feerains Main Drain Fee
r Leaders Storm Drain Fee
Sp,inkler Valves Water Sys. Fee
Permit Fee , Oa
TOTAL TOTAL FEE OD
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final