NO PERMIT NUMBER (2) K L�✓'OG� sf LOT NO,
NO. STREET
APPLICATION FOR PLUMBING PERMIT
w
CITY OF CUPERTINO
0 "✓
oSanitary No.
� I, �I
o < Date 1967 �� 17 Permit No
w LL /TTS/ Fee$
' o ApplirVi' n/is hereb) nade�o�Ihe�City of Cupertino for a permit to install plumbing
o a pipes and%oi 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
a w Cupertino, and all other laws applicable thereto.
w x
r r
Use of Premises
—o_o
� 3 Owner Address
oa
z
o Py Address
3 r- CONTRA OR,AGENT
Phone ag 4 3
w z
W w
rc a �3�y 3 WILLIAM D. HEN'::VICZi
<U State License Approved
PLUMBING INSPECTOR
FIXTURES NWN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate / Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line k-�
Lavatories 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 Drain
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" „(O
rea Drains Man Drain Pee S. 00
eater Leaders Slee in Fee j p
Sprinkler Valves Water SyS. Fee O
Permit Fee u o
TOTAL TOTAL FEE a r
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...