51064-Plumbing �� - - LOT NO.
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�',I APPLIC T FOR PLUMBING PER
" < AUG: 3 0 1965 OF CUPLRTINO
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x o S:mlCiry No.
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01 U, t� 196 Permit No S/D46.4/
w LL Fee $
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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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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Use of Premises
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F 3 Owner Address .
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3 a } CONTRACTOR, AGENT r
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a `o State License 5 3 Approved
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PLUMBING INSPECTOR v
FIXI URES
UNITS FEES UNITS 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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink -Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 70,00
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
r. ,Valves ,pO Water Sys. Fee 00
/, N Permit Fee a
OW TOTAL FEE �Qp
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final