51167N i
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111141 1 siJ CIC c A� U &J' LOT NO.
NO. STIHiEl
1 APPLICATION` FOR PLUMBING PERMIT
'C(TY ,OF CUPERTINO
I 0 -� b izGg " , - Sanitary No.
Date �' 196 Permit N
7
n'TV/ r)' Pee $ -?.15-0
Application is hereby invade to t1ie�City of Cupertino fora permit to install plumbing
pipes and/or fixtures listed un 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
Cupertino, and all other laws applicable thereto.
Use of Premises (/"AE7GC.e.J C�
Owner—d---AEkj rL0 Address ////9 Su-111EQ1AAJd %WS
BySF/2U;N0Ff
CONTRACTOR, AGENT
Phone '79 3 0/ 75?
State License toy 41(.30
Address 9yJ z1yeOCiU Adr
Sq o uosFj
PLUMBING INSPECTOR
FIXTURES 1 c
UNITS FEES
UNITS FEES
`7(/ate-Heate
Site
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 Machines
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb-Sink s Trays
To Curb
Dental Units
Drinking Fountains
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
San Traps
TOTAL FEES
Urinals t
Fixture Fee ,
Area Drains
Main Drain Fee
Nater Leaders
Storm Drain Fee
Sprinkler Valvc
Water Sys. Fee
Permit Fee , p p
TOTAL
TOTAL FEE R
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final