511751
NO. STREET
LOT
PP TIFOR PLUMBING PERMIT
P NUPERIINO
Date
FE ]. 1968 , 7 Permit No.
ITS/ n p n Fee $
Applicationlis hereby maa51 t HeT Ity:bf Cupert no for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
c� and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
U Cupertino, and all other laws applicable thereto.
d
8 Use of Premises
N Owner U Address/069///ArJ
B ✓ t /7 Address 2Z9 (F &i ce-C -, 4 e Gf .
CONTRACTOR, AGENT
PLUMBING INSPECTOR
--- r-1XURES NUMBER
MAIN DRAIN
UNITS FEES
UNITSFEES
Water Heater 1
Size
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories -
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines I .I
Size
Water Softeners
Material j
Bar Sinks' ]
To Main Drain
Comb. Sink a Trays I
JI To Curb
Dental Units _ I
Drinking Fountains 1
II
1!
Floor Drains I 1
II WATER SYSTEM
Ho-p—persl 1
11 Size
Restaurant Sinks
Ij Material
Sand —TrapsI 1
11 TOTAL FEES
Urinals I 1
11 Fixture Fee
AmaDir-ainsl 1
11 Main Draih Fee
Water Leaders I 1
11 Storm Drain Fee
Sprinkter Vanes 1
11 Water Sys. Fee
I 1
II Permit Fee
TOTAL I I
11 TOTAL FEE
RECORD OF INSPECTION