51073 ( 4E?'ae ' C LOT NO.
NO. SnEF.
APPLICATION FOR PLUMBING PERMIT
z
wa C[TY OF CUPERTINO
� n
ro �- FAQ Sanitary No.
p 4_ ^' 7
o Date Q 19 / Permit No Sid 73
3u 1967
r LL Fee $ // —
O Ap plication is hereby made to the City of Cupertino for a permit to install plumbing
r ai cs ;7- r circ. �s( {{�yeverse side hereof, and agrees to install said Hees
nd/or4T1'1YireP ar �tteI -RsJi1HVt�h provisions of the Plumbing Code of the City of
a w Cupertino, and all other Taws applicable thereto.
0 Use of Premises
00
> 3
3 Owner
0 'L�' • /L��-�L/ Addre
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By �L/� Address&J's
ONI'AACTOA, AGEN7
3
- 0 Phone "i S 7 G SJ /
0Uo State Licet� 3 } -3 Approved r^�-//
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{yam PLUMBING INSPECTOR ✓
FIXTURES
UNITS FEES UNITS FEES
Water Heam $ixe
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was'h 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 Sipks Material
SAnd Trap S, TOTAL FEES
Urinals Fixture Fee r!.'
Area Drains Main Drain Fee
lVater Leaders Storm Fee' ,_
Sprinkler valves Water $y5. Fee 4:1
w /J, Permit Fee C:%2L�
TOTAL (� TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final