51145 Aoj�pr LOT NO. zI
NO. STREE.I'
lMI FOR PLUMBING PERMIT
z a O gI'�t�OL' CUPERTINO
x ° FEB 18 1966 I�°j/� sanity rY Vin. /{�y
K LL .///W
ale
o a Uate 196— Permit No
3 4 +I�Y r�F SUP RTINO Pees �p
= o
AI ton here y ma e to the City of Cupertino for a permit to Install Plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said Prices
> I 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.
WT
r 0 Use of Premises f
oo .
3Owner QolFWAY/ w4400%*WAddress
=J � �,� �
� � By ��-�> Address d '�
O M4TRACT ,
-A,GE`NTT
3 `m Phone
w z
a o State License Approved
Approved
—U I� PLUMBING INSPECTOR
Li
FIX I URESNUMBER
UNITS FEES UNITS FEES
Water Heate Size e
Water Closets Material
bath TubsTo Curb
Showers To Prop. Line
Lavatories lee
cr,D v To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wa9h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink a 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 Volvos .Water Sys. Fee D O
Permit Fee
TOTAL 'Z2,tollTOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
\lain Drain
Final