1305 PLUMBINGo -zy(/ a
DIO. STREET
�`A D IFOR PLUMBING PERMIT
OF CUPERTINO
OCT 6 1961
Date 6? - "-,-) to - 6a , 19/! Permit No. 1,00,5—
CITY
00,5—CITY OF CUPERTINO Fee$
Applicition 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 prov. ions of the Plumbing Code of the City of
Cupertino, and all other laws appli a thereto.
d
Use of Premises
P-4
Address
_'"-B-'�q' t� Addres
'��`•: F Y 1 CONTRACTOR, AGENT
Approve
i. PLUMBING INSPECTOR
UNITS I
FEES UNITS I FEE
Water Heater I
�I Size
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories I
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
II Size
Water Softeners
sj' U �� Material I
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
I ��
Sim—
Drinking Fountains)
� II
Floor Drains
�� WATER SYSTEM
Hoppers
�( Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee g- a
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Valves
�� Water Sys. Fee
I� Permit Fee
TOTAL
�,�� �I TOTAL FEE
RECORD OF INSPECTION
Partial Roua_h nil
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