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N APPLGATIO , OR PLUMBING PERMIT
< CITY OF CUPERTINO
wQ VDEC 20 1965 -
I o Sanitary No
o Uare 196— Permit No
3 LL CITY OF Pee $
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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
a w Cupertino, and all hereto c xs Ic t
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a Use oh Premises
00
3 Own " Ru M Address
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z By e"'W/�I + �� Address i 09
O CONTRALTO&, AGENT
3
UIP-_m` Phone
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a o `State License C3 623 a 'fd 7 Appro
U PLUMBING INSPE O
I R JA.IN
UNITS F UNITS FEES
`X�ater Heate .W Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavaturies To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\`(as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
door Drains WATER SY WM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee Q
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
7-p7nkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .