51064 Z 6,1E4rcl-e¢K C; LOT NO.
APPCiC�AA,-6--;N FOR PLUMBING PERMIT
W4 VJAN
Y OF CUPERTINO
xo A 2 5 1966 Sanitary No.
5i a G SG
� LL G 3
0 < Date - Q.t.J 196 Permit No
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3 U CITY I
Fee $ T G�
LL �-
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� Application is hereby made to the 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and all other laws applicable thereto.
LL Use of Premises
00 ,/ �p�/ '� � � /
1- 3 Owner 0 /Vz_j ' ES�Si T T Address�22-ea C (2"aze G e r
� z By iCQyiJC�D�i�U,tfl� �'ie Address Z 3.6 �I! 4XU/
_T CONTRACTOR,AGENT i
a Phone
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u ft.
License Approved -�✓
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U PLUMBING INSPECTOR
FIXTURES NUJ MAIN RAIN
UNITS FEES UNITS FEES
`Suter Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'sX'ater Softeners Material
Bar Sinks To Main Drain
Comb. Sink w Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM I
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
�prinkler Vaivcs Water Sys. Fee
�- Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
:Partial Rough..
Rough Complete..
\Iain Drain
Final...