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N A_PP�LICATION7FRPLUMBING PERMIT
z < '•� —� �� LIITII�N' OP CUPERTINO
° /DEC 20 1965 S:mitary N, .
o Dare 196_ Permit No
3U
Fee $
o Arj' lTYtion -/�C hdt'(�LIRE&TINO 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
i- and/or fixtures in accordance with th irovisions of the Plumbing Code of the City of
a w Cupertino, and all othS-s ap a o.
~ ~ Use of Premises a • . ��b
a
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p O
> W
3 Owner ��/✓n Address
z By Addresses_ —
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7O�-RA
PhoneyCTORS,�AGGGN��T
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W LiState License APProc
o PLUMBING
i
TO
FIXTURES 1
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks r Not Conn.
Dish Washers Sewer Boxes
Waste Disposals S
Wash Trays — STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATERS M
Hoppers Size
Restaurant Sinks Material
Saud Traps TOTA9 FEE
Urinals Fixture Fee flim
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
5pr71cr Valves Water Sys. Fee
Permit Fee M
TOTAL / TOTAL FEE
RECOR OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Alain Drain
Final