2607 //09 Ira pabma Brivi LOT NO. /
PTR LETJ
APPLICATION' FOR PLUMBING PERMIT
FEB 281964 lc6Y OF CUPERTINO
Dat21T\�-fInCDT^�a 195_ Permit No. vU
v I��f—M-11Ids t.
Fee $ /J 0 0
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes 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
Cupertino, and all other laws applicable thereto.
Use of Premises Residence
.4
Owner_ ward Crump ! AddresPO Box 634 Cupertino
By Crowley Co Address 855 ckson Mtn View
CONTRACTOR, AGENT lYl
Phone Approved &/r
PLUMBING INSPECTOK
IXIURES I NUMBER M IN DRAIN
I UNITS I FEES II IUNITSI FEES
Water Heater � � � � S12e +i 1 12.00
Water Closets y Material Gt
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 3 �� To Existin
Kitchen Sinks �� N t Coon _
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks �� To Main Drain
Cgmb. Sink & Traysl To Curb
Dental Units I
Deinking Fountains � II
Floor Drains WATER SYSTEM
Hoppers Size f// I I_
Restaurant Sinks Material 1 1/100
Sand Traps TOTAL FEES
Urinals Fixture Fee 0i0,0
Area Drains Main Dram Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee �, OO
Permit Fee 2,00
TOTAL 1 /0 /rOTAL FEE /g!p.0
RE OR OF INS CTION
Partial Rough �7,
Rough Complete 2R —
Final — j