51009 1 j 71 L r s w C7- LOT No.
No
PLUMBING PERMIT
� d ®
JV'FOR
OF CUPfiRTINO
ro ( IuL 2 9 1965 sanitary No.
0 - sivc� q
O Ua . 196— Permit No
5 -LL CITY OF CUPERTINO Fees s�
� ° 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
I 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.
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aUse of Premises
o n n
3 Owner Gg^�� s•+ S4 „/ti. ,, Address-3
OJO <
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z By J= e �< 5 l�•, �� Address
0C AGENT
3 `m Phone 2 4;f ,36 �Za
w w WILLIAM D. SEN_VICH
a a
a o state License Approved
_U PLUMBING INSPECTOR
P- J
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 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays — STORM DRAINAGE
Washing Machines. ,.. ' Size
Water Softgne"rs Material
Bar Sinks To Main Drain
Com . Sink aw Trays To Curb
;,Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee o2-�n
Area Drains Main Drain Fee
WaterLeaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee P=o
TOTAL TOTAL—FEE °b
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
'.Main Drain
Final