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51027.7 (5) ,2o 3 y z NO. STREET © ®`A PLLII.CATIpN FOR PLUMBING PERMIT 9TY OF CUPERTINO ' o /sEP 2n 1 66 x o Sanitary No. 4 (] �. o Date 196- Permit No .S� 7 3u` oa a - CITY 4F P�RTT Q Pec $ 7 = o � Applica ion i cre } a e 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 the City of a w Cupertino, and all other laws applicable thereto. J 4 Use of Premises Or /� 9 () o r 3 Owner C /e5 -J'7 A17,1 Addressad3PJ'- n /�/ oL gy /"�Oj f'licci/n10,'AO Address 2-660 CONTRACTOR, AGENT 3 m Phone �� 2�5^�� a o State License �/e ,1V� Approved U ,I PLUA BING INSPECTOR FIXTURES NUMBER MAIN DRXTN UNITS FEES UNITS FEES Water Heate Size Water Closets Material Bath Tubs To Curb Showers To Prop. Line Lavatories J To Existing Kitchen Sinks 3 Not Conn. Dish Washers Sewer Boxes Waste Disposals asli Trays STORM DRAINAGE Washing Machines Size Water Softeners Material Bar Sinks To Main Drain Comb. Sinks Trays To Curb Dental Units Drinking Fountains Floor Drains WATER SYSTEM Hoppers Size Restaurant Sinks Material Sand raps TOTAL FEES Drina Fs Fixture Fee rea rains Main Drain Fee VVVater Leaders Storm Drain Fee 5p,i"11 VValves Water Sys. Fee Permit Fee oa TOTAL TOTAL FEE Gb RECORD OF INSPECTION Underground Rough Partial Rough Rough. Complete Main Drain Final