51104 (2) ao I n NO.
NO. STREF.I'
D I FOR PLUMBING PERMIT
I OP CUPERTINO
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x ° MAR 18 1966 Sanitary No.
as / / O
o � Date 196— Permit No C;S
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Ave
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a q'TY P QP,P1ERT N0 Pee S
� ° A pl c,do he t 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 m and/or fixtures in accordance with the visions of the Plumbing Code of the City of
a w Cupertino, and all other laws ap clic e reto.
VOL
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a Use of Premises W&"C)j
of
,, 3 Owner�/ 0� /�' Address
J z By,&t-U `9V "'"T"""' Address
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CONTR$CTOR, AGENT
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Phone a53-3305
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a
° s State Licence Approve
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l;l PLUMBING INSPECTOR
FIXI URESD
UNITS FEES UNITSI FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\t!ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink u Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
0
Area Drains Main Drain Pee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee . 40
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final