51027.7 (5) r' &✓! " 2N- iN�a�fY14'P� LOT NO.
NO. STREET / 4�
Lr ON FOR PLUMBING PERMIT
< ®
ff OF CUPF.RTINO
r 0 Sanitary No.
oJ Dat MAR 22 196696_ Permit Nn&%c) a 7. 7
<
3 Pee $
T LL
° {{� tit(rs hip n��f�� City of Cupertino for a permit to install plumbing
o a pip n /o xtures ate on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the Cary of
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises
00
3 Owner Address /-
oz By hl 'e /" �eti//.r%//1 L, Address 'G ��CC�p. vt_a
20 CONTRACTOR, AGENT
7
. Phone /
w z
w w
ao9 7 Ya
o o State License Approved
U1 PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcatc Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposals
asli Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks 'rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant SinksMaterial
San raps TOTAL FEES
Urinals Fixture Fee 01,
rea rains Main Drain Fee
Leaders Storm Drain Fee
Jprinkle VValves Water Sys. Fee
Permit Fee f'
TOTAL TOTAL FEE o0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final