51027.7 (6) /I� //cam^, �/ / •�
O 9 5 / 6 4N l /✓�O �G /Y/ LOT NO. 1 ^ A6
NO, STREET
N < PCATION FOR PLUMBING PERMIT
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z CITY OF CUPERTINO
x a Sanitary No.
4
o J t� 196� Permit No. —2 7
3 LL Pee $
x o
0 GI�pl��}} ,01cc pOtT a the City of Cupertino for a permit to install id Plumbing
o a c arN or IC�t�fe tFlA1thc reverse side hereof, and agrees to install said prices
r 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.
w x
0 a Use of Premises .r N
Z,�r
00 ,
o <Owner vS'
� 5 /�s.s iY Address �U 3 /� �y'-t iy \
z By /�/"( �5 ph Gt /Y/�Ji�G Address C1 24/r
3 Q CONTRACCOR, AGENT -;�P
w i Phone 7813 9^
< o d
State License Q ��� 9 Approved
— PLUMBING INSPECTOR
4 YYY
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as Trays STORM DRAINAGE
Wxshing'Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink--, Trays To Curb
Dente- Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers ze
Restaurant Sinks Material
an raps TOTAL FEES
rings Fixture Fee V
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
Spnnkler VaweS Water Sys. Fee
Permit Fee o0
TOTAL TOTAEF
FEE 7'
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final