51027.7 (8) T,, , ,7 n
NO. STREET
s aR
PLUMBING P
ER.M�I/T
z VUPFRTINO
° S:mitar' No.
LL fouis - !,'
° d
Date 196_ Permit No
3a V
u Fee $ 7 O
° l�ilatiddlis htj PP 9 'tb� City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures isre onreverse side hereof, and agrees to install said prices
iand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Ln
a w Cupertino, and all/other laws applicable thereto.
LL Use of Premises
00 _
oaOwner Address/,e�4//f�✓ AddressaG 9 d� �-c)-L" e�
o By / // / ec err/��il 6/dress ��G -WC 1���4VG
3 0 CONTRACTOR, AGENT
— Phone_
wz
z Uo State License ��/ q
Y� Approved i.
PLUMBING INSPECTOR
I
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcare 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
Wash- Trays STORM DRAINAGE
as Ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . S—in ksrays To Curb
Dental Units
Drin ing Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urma s Fixture Fee
rea Drains Main Drain Fee
bFater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE o0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final