51075.1 Val bEPZ I< S� `rNf
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NO. _ STHE T
N A <. ��0N`F i� UMBING PERMIT
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w � t. �l'7L�.'u [NO J = [Irnitary
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9
° J Date "1 — I 196 Permit No sl 0 7 s,/
i w t^'T"� (�r r j t Pee $ //.0V
° Application is hereby mSde to.the it�rTflCq�rt,00 for a permit to install plumbing
'o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
r I 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.
w
cUds+e of Premises
00 U A �/�P,D I f'rRIC
/ I 33 7-5-
Address
sAddress
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z By -LNG Address 0 f S+,
° wmb;N%CONTRACTOR, AGENT
3 Phone 3a-S b ALO lJ fjl. J�
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ao State License oZ3 Approved �•diLLi9.", •�•;s�
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1 PLUMBING INSPECTOR
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FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water C osets Material
Bath-Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposals
aA Trays STORM DRAINAGE
Wasing Machines Size
Water SAteners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units r
Drinking Fountains
V oor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an raps TOTAL FEESqAa.0
rinals Fixture Fee
tea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Tprinkler valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE g d
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
31ain Drain
Final