51145 (2) LOT NO. /+ J
sTRE.P.I'
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VJAN
APPLIC'ATIO;N FOR PLUMBING PERMIT
25 i956 0ITY Or CUPE:RTINO
Zi
i R Sanitary No.
0 U 1)a� U.z +6 I 1965P- Permit No 5.
w LL F UUFLn i H40
Pee $ J 1? O'TJ
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
wx
LL Use of Premises
00
oJ Owner 7 Address
z By �LOZ�r. f �1' �Ar Address ^ %,
o CONTRACTOR, AGENT
-
0 374,el m Phone 9 �`-
a o State license �C 3��� 7 Approved
—u PLUMBING INSPECTOR �/
171XTURES NUMBER
UNITS I FEES UNITS FEES
Water Hcatc 0 D Size
Wate; Closets O Material
bath Tubs p�) To Curb
Showers p B To Prop. Line G�
Lavatories p To Existing
Kitchen Sinks p Not Conn.
Dish Washers Sewer Boxes
Waste Disposals d j�
Wash Trays STORM DRAINAGE
Washing Machines d d Size
Water Softeners Material
Bar Sinks Zoo To Main Drain
Comb. 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 3 lJd
rea Drains Main Drain Fee , v
"Water Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee p d
Permit Fee p p
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
"Rough. Complete
Main Drain
Final