1984 l'/ . 7
L07 NO.
N0. !
R :PLUMBING PERMIT
W Z F1,01
F CUPERTINO
5 10 Sanitary No.
C _
O < Date 196_ Permit No ?
Appel fide ;�,F�CUPfie T�NQ� of Cupertino for a permit tonstall plumbing
O i pipes and/or fixtures listed on the reverse side hereof, and agrees to install said,prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< W Cupertino, and all other laws applicable thereto.
W S
FF
20 Use of Prem
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3 Ownef •41 Address /n 6 n u /Vo. Agi
iJ
of y - Address----
CON
ddress COS AGENT
—w one e--
W
eState License Approved
PLUMBING 1MFEC1QRJ
—rtxTo -�N U BER 11 MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heater Size
Water Closets fn^11 Material
Bath Tubs To Curb
Showers / To Prop. Line
Lavatories To E
Kitchen Sinks N Con
Dish Washers r Bo
aste Isposa
Wash Trays STORM DR AGE
ung Machines 3 Size
Wasater So Softeners Material
[farlfar Sin To Main Drain
Com m r & rays To Curb
Dents TW
Its
ing Fountains i
t• rior Drgins WATER SYSTEMI
appetsl ' Size
Restaurant Sinks Material
Ean raps TOTAL F.ES
Urinals Fixture Fee
rca rams Main Drain Fee gnn
'iNater Leaders Storm Drain Fre
Sprinkler Valves Water Sys. Fee
Permit Fee
OTA L _ TOTAL (:EE
RECO OF WSPF4TION
Underground Rough... (o
.partial Rough..
:Rough: Complete..
'Iain Drain r
Final... �-
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ip
go
ro
jo.
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