NO PERMIT NUMBER /a=.�J'7 Xfi-f CNO L C YO LOT NO. / D
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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[CIT rOF CUPERTINO
s o Sanitary No.
O a Date �_�_ r �9 195J , 1A6-d'-, Permit No
w Fee $
LLw AppliFation/is-Fferebyrrtiad'erfohe�City of Cupertino for a permit to install plumbing
O a pipes and%or fixtures listed' 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 City of
a w Cupertino, and all other laws applicable thereto.
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w Use of Premises
00
W D.9�< CCN GC.. Go
0 3 Owner Address
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z By eAC4- �L&9 Address
a CONTRACTOR, AGENT
3 o?JV-9'077
- m Phony
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t >aLIAivI D. EcIVEVIC;i
a l�o)))) State Livens 3 g Approved
7 PLUMBING INSPECTOR r
FIX I URLS NUN BLR MAIN DRAIN
UNITS FEES UNITS FEES
`.Vater Heate / Size
Wate: Closets Material
Bath Tubs To Cur
Showers To Prop. Line {/
Lavatories s To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposa
as"h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material 4&_VI
San raps TOTAL FEES
Urinals Fixture Fee'
y��r�ea rams Main D ain Fee
Water Leaders Ste ain Fee rfy
Sprinkler Valves Water Sys. Fee
Permit Fee p)
TOTAL / TOTAL FEE 40
RECORD OF INSPECTION
Underground Rough_.
Partial Rough..
Rough. Complete-
Main Drain
Final...