51145 2/s// I 67 LOT NO. is
NO. S F.l'
N c�PPSl CAFl ' 'N FOR PLUMBING PERMIT
` OITk' OF CUPERTINO
, 0 (JAN 131966 Sanitary No.
o a Dnte 196_ Permit No.
3CITY OF CgPEI�TINO
w Fee $
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Application is here y mac e 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
ain
Cupertino, and all other laws applicable thereto.
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` Use of Premises J• �•�f�L.
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3 Owner a Address
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j z Uy Address
CONTRACTPR, AGENT
3 Phone
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W . �3d�7
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a o State License Approved
U �� PLUMBING INSPECTOR /
FIXTURES NUMMAIN DRAIN
UNITS FEES UNITS FEES
`Nater Heate Size
Water Closets '3 Material
Bath Tubs To Curb CZ
Showers To Prop. Line
Lavatories j 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 D ain
Com . 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 / Z.Od
rea Drains Main Drain Fee pp
tV—ater Leaders Storm Drain Fee
spnnkler Valves Water Sys. Fee p e
Permit Fee Z-t9J
TOTAL fop TOTAL FEE 17,90
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .