51001.2 (3) I'1 Ann Ct LOT NO.
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I FOR PLUMBING PERMIT
Z z fAUG �. 7 19661TY OF CUPERTINO
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0 a Dir rTyE1U USt 12 196 6 Permit No
3 U LTPLUM, Fee $
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Application is hereby made to the City of Cupertino for a permit to install plumbing
`opipes 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
<w Cupertino, and all other laws applicable thereto.
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� 3 Owner Franklin—Bahl Dev. Address P.O. Box 911 , Campbel:
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� z By Central Sarvi rt-, (;n_ Address 1651 QUP.eg Lane
3 < 2CONTo556 AGENT �a- Jose
— Phone 9
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E State License Y> � '�� ��'� Approved
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' PLUMBING INSPECTOR
FIXTURES M MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater o o Size
Water Closets 3 3,co Material
Bath Tubs To Curb
Showers , o rop. Li
Lavatories Is g m
Kitchen Sinks ,mp Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'skater Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
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Drinking Fountains I
Moor Drains WATER SYSTEM I
Hoppers Size /
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee .dt7
Area Drains Main Drain Fee
\hater Leaders Storm Drain Fee
Sprinkler Vaives Wate[ Sys. Fee ,00
Permit Fee ,pv
TOTAL Z,,�t, TOTAL FEE p�
RECORD OF INSPECTION
Underground Rough...
.Partial Rnugh..
Rough. PI, C..
Main Drain
Final_..