51114 /a 393 1 C-A%^A � ' LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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u z CITY OF CUPERTINO
x o Sanitary No.
RLL J �j
0 a Date / — `� 1961 Permit No
3U
I n Fee $
0 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
> 1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all of er—laws applicable th to. b
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LL Use o miser
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3 Ow ddress
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z B O Address /J
0 CONTRACTOR
AGENT
3 0 Phov Y13- o
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aoState Lice / �y Approved
PLUMBING INSPECTOR
FIX r URt's NUN BER MAIN DRAIN
_ UNITS FEES UNITS FEES
Water Heate Size
Wate; 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 r Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink-,, Trays To Curb
Dental Units
Drinking Fountains Alffim
Moor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee'
rea Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler Volvcs Water Sys. Fee
(y Permit Fee
TOTAL TOTAL FEE
R CORD OF INSPECTION
Underground Rough...
Partial Rough-
Rough. Complete-
iMain Drain
Final._