51145 R'er0W I awAwA * �T' ` LOT NO. 2151
NO. STREET
N a LITION FOR PLUMBING PERMIT
z i C`h Y OP CUPfiRTINO
W
r o Sanitary No.
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o a Uate� (� I q96— '; � Permit No 4/
Fee $ 1.
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pppJi ati lis erggb,}}]],m,,ff� Aq�' City of Cupertino for a permit to install plumbing
`o pi sl�n�/o�bxtuic+.illfst�.1k41I�1treverse side hereof, and agrees to install said prices
a : 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.
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a Use of Premises
00
oa Owner-74'k'tf'P . Address
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o By_(J,,=-+� K� Address rob t
3 F CONTA CTOA, AGENT
— W Phone
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¢ ° 290 ` 7167
< 0 State License Approved /
U PE7IEING INSPECTOR r�
FIXTURES J BER MAIN DRAIN
(UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing MachineSize
\rater Softeners Material
Bar Sinks To Main Drain
Com . Sink s TraTo Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material Cow,
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Pee M
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final