51123 i�0%�3 ✓ ti%17jf.' LOT NO.
MO. $TREEI'
N A- P.PLICATIO.N FOR PLUMBING PERMIT
` `Y OF CUPERTINO
z
x ° ?JAN 24 1966 Sanitary
o j Date 196— Permit No
3 < O-o I
u TVV nn ((S�IIII [[pp ff(p�11((�� Fee
° A�p�lltcitticDF hbrAtlyPtV�l�tH�ih� City of Cupertino for a permit to
stall Plumbing;
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m` 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.
0 w Use of Premises r �.
00
7 N
o a Owner ��� Address
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z By .evxPi'✓ Address
° CONTRACTOR, AGENT
3 �
— W Phone /4z-
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a o State License Approved
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PLUMBING INSPECTOR •. /
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
�r/ater Softeners Material
Bar Sinks To Main Drain
Com . Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /, 00
rea Drains Main Drain Fee Q 0
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee 1. 66
Permit Fee ,0 0
TOTAL 0U TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final