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� 'APPLIGATION FOR PLUMBING PERMIT
N
a „C,�ITt' OF CUPF.RTINO
ro DEC '210 1965 Sanitary ,.
Q
° 4
a Uare 196— Permit No
3 LL CITY OF CJPERTIM Pee S
° Application is hereby made to the City of Cupertino for a permit to install plumbing
a a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in . ince "I t the provisions of the Plumbing Code of the City of
a w Cupertino, and all Cher 1 —FIN
p thereto.
w Use of Premises _ y�
00
7 N
r 3 Owner Address
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By � 9-L�ti1n Address - �'/ '
_ CONTRAF;TOR,AGENT
3 `m Phone '
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s o State License C3 C 2-3° uo J Appro
—O�1 PLUMBING INSP TO
FIX R D
UNITS FEES UNITS FEES
BLR MAIN DRAIN
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers - To Prop. Line
Lavatories z 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 v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATERS EM
Hoppers Size
Restaurant Sinks Material
SanT Traps TOTAII FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinklcr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final