51145 Z1413 I ^^1� rLOT NO
NO. 7/} E i f3�
:LIGATION OR PLUMBINGPERMIT
z a CILW SOP CUPERTINO
E ?(DEC 20 1965 sanitary No.
xo
O a II
j LL Uate 196_ Permit No
CITY OF CUPERTINO Fee $ /
o App ,cation 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
z I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all of a s thereto.
w x
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LL Use of Premises
00
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0 3Owner - �� i Address
o a /
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� z By �->-+�-�-�. %� /� Address—
CONTRACTOR,
ddress / /� �` 5
3 CONTRACTOR, AGENT /
w i Phone '7���C��� /�
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as CY Z3Q�p
a o State License Approved
U PLUMBING INSPEC OA /
V
I-I, URES NUMBER MAIN DRAIN
UNITS FE UNITS FEES
Water Heate Size
Water Close's Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Disb Washers Sewer Boxes
Waste Disposals
Wasli Trays STORM DRAINAGE
Washing Machines Size
ffn
Softeners Material
ks To Main Drain
Sink-& Trays To Curb
Unitsg Fountainsrains WATERS Trs Sizeant Sinks Materia
raps T FEES Akft Fixture Fee ltrc
Arca Drains Main Drain Fee
VErater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Slain Drain
Final