51145 (2) l�6 /�lG �I `i!'f Y V L./Q iGC.C.f✓ \ LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
xw < �1TY OF CUPERTINO
o A1 Sanitary No.
o < Date T I Permit No J -/Z
3QUN 10 1966
w" Fee $
x LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes an( /t etu lis c side hereof, and agrees to install said rices
> a and/or f111e�in turdUU ovisions of the Plumbing Code of the City of
a w Cupertino, and all 6ti-er laws applicable thereto.
w 2
LL Use of Premises -<-+�-��-•�S �N` G
0000
> V 11
3: //_�Ar Address i`oa 4 f`
o syr Nom' ` R� 'a Address/�//i •e ti�Ge° ` �� �IfL
y `ITRACTO (t E� �/
a o State License' / C1 ApprovedW
_V PLUMBING INSPECTOR
(_ J
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heate Size
Water Closets Material
Bata Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was71 Trays I STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor 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 Valves Water Sys. FK Od
Permit Fee o O
TOTAL J TOTAL FEE v a
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final