51145 LOT NO.
NO. STR F.F.I'
N
P A ON FOR PLUMBING PERMIT
< TY
OF QIPERTINO
z z
x o Sanitary No.
o < n �JUL - 8 1966 196_ Permit No-
Fee S
1 LL
the City of Cupertino for a permit to install Plumbing
o` a pipes and/or fixtures Isle on e 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.
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LL Use of Premises7G- o'L_
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o a Owner��// rL�� ��'/U Address ZAG/(/
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j 0 By' AddressJS.5 W 7 r�
CONTRACTOR, AGENT
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- 0 Phone 3 -Ili h
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a tate License /J 33 S�3 Approved
UK ? I PLUMBING INSPECTOR '/
I.
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
W as?h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink ,% Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
/, Fixture Fee
,0o Main Drain Fee
L ,00 Storm Drain Fee
alvcs pip Water Sys. Fee
Jkla0b /,10 Permit Fee �d0
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final