51071LOT
STREET
`APPLICATION FOR PLUMBING PERMIT
T 24 'gs 6 CITY OF CUPERTINO
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Date.00tober 18 1966 Permit No. 3 O
Fee S 4.00
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
v
OwnerE. Cutatorth Address202O5 Apple Tree Ln.
By Address380 E. Eve19n
CONTRACTOR, AGENT
1 Phone Approved
T
1iX PLUMBING INSPECTOR
V
' FIXTURES I NUMBER MAIN DRAIN
UNITS I FEES 11
IUNITS1 FEES
Water Heater Size
Restaurant Sinks
Water Closets Material
Bath Tubs To Curb
TOTAL FEES
Showers To Prop. Line
Fixture Fee
Lavatories To Existing
Main Drain Fee
Kitchen Sinks Not Conn.
Storm Drain Fee
Dish Washers
Water Sys. Fee .
Waste Disposals
Permit Fee
Nvl-1 T....., I I If CnD At no AYXTA(r
TOTAL FEE
ns
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals 1 11
Fixture Fee
-1
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler. Varves
Water Sys. Fee .
Permit Fee
TOTAL ,���
TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final