51043.1 (5) 3e(-o ) I V /�� LOT NO.
NO. STREFY
APPUJCATI^Ll FOR PLUMBING PERMIT
"
Zi a � I uprxrlNo
x o ® Sanitary No.
o a Date 1968196 -- Permit No V :%. /
3U a
w � Fec $ .I ,
o
A � licatigq`s��ere� naQ��,J �t Cupertino fora Permit to install plumbing '
`o pipes and/oErfi�FtdresUi�ed`AA'th�}Tdcisc side hereof, and arees to install sid rricc
> and/or fixtures in accordance with the provisions of the Plumbing Code of the GV of
a w Cupertino, and all other laws applicable thereto.
Use of Premises
0 0
oa Owner ..O�7Adclress
z
o By���i �✓ Address
3 0 CONTRACTOR, AGENT
Phone :? ,y —1 .17 d
w z
� a � tN�LLt -..�1 u. i�NEVICH
a o State License -/ G a Approved
—U4_ PLUMBING INSPECTOR
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Materia!
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
'%rater So tenets Material
Bar Sinks To Main Drain
Com . Sink -& Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
uppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Unna s Fixture Fee
tea rains Main Drain Fee
Water Leaders Storm Drain Fee -
Sprinkler Valves Water Sys. Fee
Permit Fee A
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final