51125 /o3 0
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT G
" d CITY OF CUPERTINO
z
x o Sanitary No.
LL f= 3o - / �
a Date 196 6 Permit No
30 LL Pee $_
T o
Application is hereby made to the City of Cupertino for a permit to install plumbing
`o < 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
i m Cupertino, and all t aws applicable o.
W x �1
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a Use of Prem-, s
00
> 0303 Ow r Addres
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CONTRFCTtR, AGENT
— 0 Phon` - �`��
ao State Licens — `� v Approved
PLUMBING IN4OR
Ix
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 11 Sewer Boxes
Waste Disposals
%Vaih Trays STORM DRAINAGE
Washing Machines Size '
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
mer Leaders Storm Drain Fee 0
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough_
Rough. Complete_
Main Drain
Final...