51137 (3) C�a/ I Y^-Gu / (',, LOT NO.
NO. 0 F.i
D N FOR PLUMBING PERMIT
< bv ITY OF CUPFRTINO
EB 7 1966 Sanitary No.
fo
Y / '1
¢ LL r//.? .
° J U 2 19(>L Permit No
3u
I n CI Fee $
o Application is hereby made to the City of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on the 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.
Use of Premises �iP�lJf�% �Cl o L_
00 /
r3 OwnerC� L U/���/LiJi✓',T� Address�o/32 Las 4y"'y-S Ci
O JLv C:S�� ,
z By ,�9` NfT Address 7T�f ST
CONTRACTOR, AGGNT
3
- 0 Phone Cy 7
w z
w w
%,
, I /
a o State License �5 33 3 Approve
U��. .PLUMBING INSPECTOR
FIXTURES D
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
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers a.c,/ 2/ O' Size
Restaurant Si rs Material
San Traps % TOTAL FEES
Urinals Fixture Fee 3
Area Drain Main Drain Fee
lVater Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee
Permit Fee _ •'3-
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final