51009 LOT NO.
NO.
D A FOR PLUMBING PERMIT
a Y ON CUPERTINO
_ = IJuL 22 1965
x o Sanitary No.
R LL /�lo�
U ddPERT1W
a 16, 196 S Permit No J 91
i w Pee $�
O Application is hereby made to the City of Cupertino for a permit to install Plumbing
'o < 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.
w x I
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j LL Use of Premises 5/ S=it A
00 //
' " Owner _ Address33S13°
o a aee/1-I
do
o By �GITT � Address
3 0 CONTRACTOR, AGENT
Phone !�226 — 30 4
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a0
o01`� State License Approve
VPLUMBING INSPECTOR
T
FIXTURES A
UNITS FEES UNITS FEES
Water Heate S1ze
Water Closets Material
bath 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
Com . Sink s Trays To,Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San TrapsTOTAL FEES
Urinals Fixture Fee , p.
Area Drains Main Drain Pee
Water Leaders Storm Drain Fee
Jprinkler Valves Water Sys. Fee
Permit Fee I p
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final .