51001.3 (2) /O b / I ���..AiY, 4-,-4'O. Q . LOT NO. t�
NO. STREET
LITION FOR PLUMBING PERMIT
'z a Y OF CUPERTINO _
r o p Sanitary No.
o a Date /MI&KH �9 961E Permit No s 3
3� "yG.I�
Fee $
= o [
's e �� e City of Cupertino for a permit to install plumbing
o a pipes and/or hxtu 'fisdlttipJ reverse side hereof, and agrees to install said prices
i a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all otheer� laws applicable thereto.
.a, 4 Use of Preises
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Address4x.e, 4Vru_
z By ( J` J� tic-e l" (!d• Address
CONTRACTOR, AGENT ai
3W Phone. X93— C�Or'j
w z
Qo State Licensr a3 5 ��` Approved
U PLUMBING INSPECTOR
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Haate Size ¢'
Water C insets Material �./.
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn. `
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units .GI
Drm ing Fountains
F' oor Drains WATER SYSTEM
oppers Size
Restaurant Sinks Material G,qv
an T Traps TOTAL FEES
Urinals Fixture Fee
rea rains Main raic Fee
Water-Leaders n Fee XV
Sprinkler Valves Water Sys. Fee /•;ry
Permit Fee .0-0 o
TOTAL TOTAL FEE y
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
N'Iain Drain
Final...