2676 LOT NO.'
�AP �L} T1 iFOR PLUMBING PERMIT
< OF CUPLRTINO
zz
r o Sanitary No.
o UatCITY OF4DJPERTiNQ964 Permit No
i w Pee $
O 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
i N 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.
w x
w Use of Premises RESIDENCE
00
> w Ward Crump PO Box 634 Cupertino
o a Owner Address
PO
By Crowley Co 855 Jackson Mtn View
o Address
3 r CONTRACTOR,AGENT
— 0 Phone
w Z
w w
¢ a
o a State License. ]RR99R Approved
—U
PLUMBING INSPECTOR
I - MAIN DRAIN
UNITS FEES i UNITS FEES
Waret)Heate Size UD
Wars, Closets y Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
'Was—Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drin mg Fountains
Floor Drains I WATER SYSTEM
Hoppers rFixture
-— / 00
Restaurant Sinks Ca,1ze.e-
San Traps TAL EES
Urinals e °°
renDrains n Fee -Y O°
in Fee. FeeSprinkler Valves e vo
TOTAL p TOTAL FEE
RECORD OF INSPECTION
Underground Rough... -
Partial Rough..
Rough. Complete..
Main Drain
Final...