NO PERMIT NUMBER (3) 21746 COI,LINGSWORTH
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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<s CITY 4k- PE O
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Uate Sept. 18 9 8 Pcr IiiNo
3 u 14 1968 Pee s _3.50
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed ({nIthc/reno5e SJJ�ejhere ndrgreen to install said'priccs
> I and/or fixtures in accordanccrWillt th��lprnvhl�n's �i0ihe NO bing Code of the City of
a w Cupertino, and all other Taws applicable thereto.
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LL Use of Premises HOUSEHOLD
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3
Owner 1) R—ADAW4 Address 21746 COT I TNGSWOUM
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0 �ONTR CTO,, AGENT
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- Phone 379-5050
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< 0 State License 234281 Approved
—0 PLUMBING INSPECTOR
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FIXTURES JfBER MAIN DRAIN
UNITS FEES UNITS FEES
'Vater Heatc I 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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final .