2706 • c� .�D�1J I G�,E�EE.G'S/OE G/IJU.Q% LOT NO. S�
NO. S'��
DITIA FOR PLUMBING PERMIT
a ITY OF -UPERTINO
o ,/APR 17 1964 " '' Sanitary No.
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0 a Date 19 Permit No
3 CITY OF CUPERTI1!^, Fee $ 1s<'06)
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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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Use of Premises
00
3 Owner Ove GLG/OT Address IeI08/V, Clizr/ESTFe, S�
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30
CONTRACTOR, AGENT
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oState Licens �7Sa 9 Approve
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p PLUMBING INSPECTOR
FIX-1 URES NUMBER MAINDRAIN
o UNITS FEES UNITS FEES
Water Hearer 1079 Size
Ware, Closets �7 ,en Materia'_
Bath Tubs 09 To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
\trashing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Draini WATER SYSTEM
Hoppers Size �//
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 00
Area Drains Main Drain Fee
Water Leaders Storm Drain Fce
Sprinkler Van-cs Water Sys. Fee
Permit Fee a,
TOTAL , 19a TOTAL FEE �D
RECORD OF INSPEC ION
Underground Rough.' _
.Partial Rough_
.Rough. Complete.. —
Main Drain
Final...