2472 LOT NO. /267
NO. STREET
APPLICATION FOR PLUMBING PERMIT
N �
zi
I
�/ I�TY OF CUPERTINO
0 r Sanitary No.
3 0 -
a Dat e3 l-I, 19b Permit No
W 0 vv n/�
Pee $ /Z —
1 ° AppliIiohll-s he eb}?tna, o the City of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> i- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
WCupertino, and all other laws applicable thereto.
LL Use of Premises . RESIDENCE
00
3 Owner Li/*(ZP GiPii Wk' Address
oa
zJ
z By lid'/XdLE✓ GOr Address
_ o
3 r CONTRACEOR, AGENT
a
z Phonr
-
w z
rc a �6�97 X
02 State License Approved
ao
_U r..��TD.rTnn •nr.nor
PLUMBING INSPECTOR
FIXTURES NU,% BER MAINDRAIN
UNITS FEES UNITS FEES
awr Hcater Size ;p
rater Closets 'Material pl—
Hath Tubs / To Curb
Showers / To Prop. Line..
Lavatories To Existing
Itchen Sinks Not Conn.
ish Washers Sewer Boxes
'rite Disposals
Wash Trays STORM DRAINAGE
Gashing Machines Size
'%Vater Softeners Material
Lia! Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Dunking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /ro
Resta'arant Sinks Material
San Traps TOTAL FEES
1Urinals Fixture Fee
Arca Drains Main Drain Fee , oa
Water Leaders Storm Drain Fee
-7p—,-nkllr Vmvcs Water Sys. Fee Op
Permit Fee ,pp
TOTAL /y _ TOTAL FEE /J, 00
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
\lain Drain
Final._
JI .