NO PERMIT NUMBER (3) 10248 COLD HARBOh AVE LOT NO.
NO. STREET
APPLICATION FO P UMBING PERMIT
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o Se t. 27 F , ON—l4 1968
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Application is hereb� ma-1-' he �{- Cor permit to install plumbing
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0 pipes and/or fixtures Ii-. onrthe mversclsrde, het o.,Ifll agrees to install said prices
. a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
a 4 Use of Premises HOUSEHOLD
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o a Owner KART H VArWFR Address 10248 COLD HARROR AVE,
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� z By SOFPMASTER, INC. Address P.O. BOX 696, CAMPBELL
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� CONTRACTOR, AGENT
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— Phone 379-5050
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a o State License 234281 Approved
-U PLUMBING INSPECTOR
FIXTURES NUDf
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 s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps j ( TOTAL FEES
Urinals _ (('. D Fixture Fee
Area Drains ,� ' ' (jVI. I Main Drain Fee
�r/ater Leaders jJ('1 '1 ( Storm Drain Fee
Sprinkler Valves L Water Sys. Fee
Permit Fee
TOTAL I TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\•Iain Drain
Final