51089 10706 TA nda Vista Dri vA ) LOT NO. 3n
-k'Lt 10N FOR; PLUMBING PERMIT i
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CITY OF .CUP[RT[NO
m BSEP l � 1965, Sanitary No.
o ] Date Sept. 196_5 Permit NoS/.92: —
=o CITY OF C iPE TI.'0 Pee $
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
> 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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LL Use of Premises Residence
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7 N
O < Own(F'Tankl in_Rahl r.onst. Address P n Rnx olh Cg; ppbell
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n, Central Service Co. Inc. Address451 Queens Lane, J.
3 By
CONTRACTOR, AGENT
w i Phone 29$-0556
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us State License 171537 A roved WILLIAM D. SENEVICH
a o PP
PLUMBING INSPECTOR
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FIXTURES M
UNITS I FEES UNITS FEES
Water Heate f pg, I Size P O 0
Water Closets �, .2 Material L -
Bath Tubs o To Curb
Showers 1 vo To Prop. Line
Lavatories o To Existing
Kitchen Sinks / Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines e C Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material ht
Sand Traps TOTAL FEES
Urinals Fixture Fee 10 0
Area Drains Main Drain Fee LV V
Water Leaders Storm Drain Fee
-prink," Valves Water Sys. Fee 1 0
Permit Fee A 0 1r
TOTAL V ea TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final