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APPLICATION FOR PLUMBING PERMIT
CITY
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1 8 1960
OF CUPERTINO
Permit No. 67.;::5-67
Fee $
ppicetiou is j to the City of Cupertino for a permit to install plumbing
C�Tp s and/or fixturea'b� 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 o r laws applicable thereto.
Use of Premises-�-t '✓� j
Owner`(✓ L "
By
A4 S
N CTOR,ENT
Phone , , 0 7
Address /O S 7 k 0•..
Address 7;L/
Approve
PLUMBING INSPECTOR
I UNITS I FEES 11 1 UNITS I FEES
Water Heater I I 11 Size I
Water Closets i I II Material I I
Lavatories I I
II To Existing
Kitchen Sinks I I
II Not Conn.
Dish Washers I I
II SEWER BOXES
Waste Disposals I I
II
Wash Trays I I
II STORM DRAIN
Washing Machines I I
CII Size
W
')Water Softeners I r I
Bar Sinks I I
Material
II To Main Drain I
_Comb. Sink & Trays I
Dental Units
Drinking Fountainsl
I II To Curl
I II
Floor Drains
WATER
Hoppers I
I I Size
Restaurant Sinks I
I II MntPrinl
L FEES
urinals I �I kixture
Area Drains I I II Main I
Water Leaders I I II Storm I
Sprinkler Valves I ( II Water
Permit
TOTAL I II IOTA:
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final