51087 (2) 10737 TJ nda Vi sta Dr_ LOT NO. 5
NO. STREF.I'
z < jaAM IrjJON FOR PLUMBING PERMIT
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w ® CITY OF CUPERTINO
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SHEP14 1965 sanitary No.
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0 ' Date 4Ppt 13 - 196-5 Permit No ��O � 7
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o CITE' PF. UPE�TINO Pee / '—
pp cation is here y 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
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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w Use of Premises Re Slden Ce
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oa OwnerF2ntr13-n—Bahl rOnSt Address P_0 Box 911 ( aT_ e11
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; o ByCPntral Servi_ee Col Inc Address451 Queens Lane, S. J.
F CONTRACTOR, AGENT
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Phone 298-05,5+6
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a o State License Approved b
PLUMBING INSPECTOR C/
FIXTURES NUMi MAIN DRAIN
UNITS FEES UNITS FEES
`XVater Heate / (J O Size OC
Ware, Closets Material
bath Tubs To Curb
Showers a To Prop. Line
Lavatories To Existing
Kitchen Sinks W, 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 WALTER.SYSTEM
Hoppers Size f a o
Restaurant Sinks Material bq<,
San Traps TOTAL FEES
Urinals Fixture Fee 0 U
Area Drains Main Drain Fee V
Dater Leaders Storm Drain Fee
-pnnkler Valves Water Sys. Fee 6t
Permit Fee 70 p
TOTAL (3 TOTAL FEE I 5e) Q
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final