51087 LOT NO.
APPL'ICtjiON FOR PLUMBING PERMIT
a ' ® jC�] „CITY OF CUPERTINO
w z (DEC 21 1965
rc o Sanitary No.
3u CIT 44 1961 Permit No. mac! 7
a
CIT
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w LL Fee $
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Application is hereby made to the Ci of Cupertino for permit to install plumbing
LL W
PP Y h P P ai g
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said pnccs
> 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 -L S
00
r 3 Owner f '''�Rddress JV&7 .4/1*4 4G 4 10
z By 1 f,4 Address 17�71_i '" S
O CpNTRA OR GENT
0y— Phone
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a o State License, -Approved
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{\� PLUMBING INSPECTOR Ve
FIXTURES NUMBERI R I
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Matcral
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
'.Mater Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee `Area Drains Main Drain Fee
Cater Leaders Storm.Drain Fee
Sprinkler Vaivcs Water Sys. Fee
Permit Fee �•_°
TOTAL TOTAL FEES
RECORD OF INSPECTION
Underground Rough...
.Partial Rough-.
.Rough. Complete..
Main Drain
Final---