51037 II a#(L O � �r� k•�+ �� LOT NO.
STREET
APPLICATION FOR PLUMBING PERMIT
u, a CITY OF CUPERTINO
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x o Sanitary N0.
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0 a Date y 196,W4'0'
96 aNo V 101 7
3
i LL Fee $
° Application is hereby made to the City of Cupertino for a permi to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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 HOUSEHOLD
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3 Owner Robert Montrose Address 11046 Linda Vista Dr.
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z By r'nast Water Softener Co. Address 807 The Alameda
O CONTRACTOR,AGENT
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— < Phone 295-3435 i r
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ao State License /-A-3590 3 Approved i
—U
UMHING INSPECTOR
I. NUMBER
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 Softeners �bo Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rinals Fixture Feeo t
re-Drains Main Drain Fee
Zr/ater Leaders Storm Drain Fee
Tpl-, loll V:dlesWater Sys. Fee , oD
Permit Fee '7.. o
TOTAL / ,00 TOTALFEE 4,00
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough, Complete..
Main Drain
Final....