51123 LOT NO,
NO.
crl FOR PLUMBING PERMIT
y OP CUP 'RTINO
r 7
x o 1 OCT 26 1967 ' Sanitary i\�n.
¢ �
0 < Uatele -a y' , 196/Z Permit No S /z a .3
3 LLCITY OF Cl1RERTINO Fees .�o
O Application 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
i I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other I vs applicable thereto.
w Z
� r
a LL Use of Premises
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0 3: Owner Ae Address .�_
z
z IIy Address
CONTRACTOR, ACE
3 W � --�G
— m Phone
w z ,p,J WILLIAM 7. R]f'N -`./ICH
a a State License �•7�� Approved
—U PLUMBING INSPECTOR
I. R NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
`.Vater 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
Wasli Trays STORM DRAINAGE
Washing-Machines Size
Water Softeners Material
-Bar Sinks To Main Drain
Com Sink To Curb
Dental'Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinll VJValves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final