51001.2 (2) LOT NO. /7
f O. STREET
APPLICATION FOR PLUMBING PERMIT
z CITY OF CUPERTINO
r o Sanitary No. � .
0 a Date , J'/ 1966 Permit No. �l°O�
w LL IVI 1 Fee $ ox�F1-0
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Application is hereby made t th City of Cupertino for a permit to install plumbing
o piperor(}}:ffur�s ��r�I���reverse side hereof, and agrees to install said prices
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andMr ture{tin a cordancc with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w 2
,. Use of Premises
00
J�y/�g Address/01-1 �
z By "r"� � 6/' OV4 Q�. Address's-�
OCONTRACTOR, AGENT
— 0 Phone
w Z
w w
a State License
Approved '
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Nu Y MBING INSPECTOR
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RNUMbER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate t Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories ,f� To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wasp Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink m Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material *W
San Traps TOTAL FEES
Urinals Fixture Feerd17
rea Drains Main Drain Fee dr00
Water Leaders in Fee /,,fD
Jprinklcr Valves Water Sys. Fee I,J"d
Permit Fee y
TOTAL 13 TOTAL FEE S—e
RECORD OF INSPECTION
Underground Rough...
Partial Rough-
Rough. Complete..
Alain Drain
Final...