51027.7 (2) �.?Iy4; Ql L41�6/� LOT NO.
NO, STREET
V
FOR PLUMBING PERMIT
a OF CUPERTINO
r o AR 22 1966 Sanitary No.
¢ /off 7.
0 � Date 196_ Permit No `7/ � 7
3 `
CITY . OF CI�PEVJl Q Fee $ `—
2 LL
O pp kation is SIM), ma e o e City of Cupertino for a permit to install Plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
a a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
z) Cupertino, and all other laws applicable thereto.
LL
Use of Premises i /Q0 F-04.C ' 1' L
00
3 OwnerAddress
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J o By�! ��/ Address
j F �ORAC OAGENT /mow
— m Phone
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a2 State License !6� 2 " Approved
U PLUMBING INSPECTOR
I.I X-I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water C asets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To,Existing
Kitchen Sinks Npt Conn.
is Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Was inr ng Mach nes Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
uppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rinals Fixture Fee L./O o
pArea Drains Main Drain Fee I
VV-ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee .�-�a
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final