51027.7 (4) —jkj_ ,l LOT Nn.
NO. STREET
1
z - `APP,�LLICATION FOR PLUMBING PE M�hTY OF CUPERTINO
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r 0 IDC I �.0 .�.1 Sanitary No.
3 a Date f z 196— Permit No
U Fee 5 6
° liff'.Ii. ifr sttfi!ale'ttt� the City Cupertino for a permit to install plumbing
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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.
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Use of Premises ie a S
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Owner//B�Mii i7/ Address 70 �I/ �`�f/rte
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O CONTRACTOR, AGENT
3m Phone � � ` 5S E� '� �•
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< o State License P-09 e Approve
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
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Size
ets Material
To Curb
To Prop. Line
To Existing
cs Not Conn.
sasers Sewer Boxes
Waste Disposa s
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
BarBarSinTcs— To Main Drai '
Com . Sin s rays To Curb
Dental Units
Drinking Fountains
t'loor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an taps TOTAL FEES
rinals Fixture Fee O
re., rains Main Drain Fee
WaterLeaders Storm Drain Fee
5prinkler Volvos Water Sys. Fee
Permit Fee c
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
'Hain Drain
Final