51001.20,39'7' I Bl -vv LOT NO. 4n6
NO. STREET
APPLICATION FOR PLUMBING PERMIT
O
'z z rn x 0 OF CUPERTINO
Y a �. —� 1� �� Samitary No. -0s Z7
Date'196 ? Permit Note
i a Fee $ .26,4'o
O Application is hereby made to the City of Cupertino for a permit to install plumbing
`oa pipes arfd�Tfixtures hF.JdPEjT1e frZ! rse side hereof, and agrees to install said prices
z and/or fixtures m accordance will) the provisions of the Plumbing Code of the City of
¢ w Cupertino, and all other laws applicable thereto.
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0 4 Use of Premises
00 A A
3 Own---��..� —vvLV Addressd+'--,�
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a �/�/� /
z By �-Q Q .es�i�r.eJ''-DLJ Address
CONTRACTOR, AGENT
Phone '7 7
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a o State License cZ �_$� Approvedrn t tnu r F"NF's17^.[2 /
U(I PLUMBING INSPECTOR ✓
FEES I
Heate
lul
V a l,es
LAO -J-4 RECORD OF INSPECTION
Main Drain
Final
/rg39 7
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Dat 1942 Permit No. S/ C d /, A--,
ppllcahon is hAy ma�e t(6 the City of Cupertino for a permit to install plumbing
pipes and/or is
listed on the reverse side hereof, and agrees to install said prices
�f fi8&es{ilj P"{�,�(p�ih the provisions of the Plumbing Code of the City of
upertmo, and `al` j o er wls� `a"pplicable thereto.
Use of
Address
Address,:f�
Approv
PLUMBING INSPECTOR /
Water Heater
ng
Hoppers Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
1 Sprinkler Vaives Water Sys. Fee
RECORD OF INSPECTION