51064 LOT NO.
O. STREET
FOR PLUMBING PERMIT
?tAPR
, OF CUPERTINO
"7 '1966 Ir
Date Apri l F 19,E Permit No. I lG
CITY OF CUPERTINO Fee s4-0
10
Application is hereby made to the City of Cupertino for a permit to install plumbing
10
ri 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 Cupertino, and all other laws applicable thereto.
Use of Premises
0
Owner John Gates Address 223-17 Clearcreek Cwt*'
ByRaMe Soft Water SerViCGd0k Address 243—B Moffett glyd
CONTRACTOR, AGBNT
Phone — Approved '/
�}- PLUMBING INSPECTOR iY
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets I �� Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers it
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains) II _
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives I Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final