51037 1109 Linda Vista fir. LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
z
x o Sanitary No.
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o j Date L 196je itwa No .r10 ?
i, Fee $ i
O 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
a 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.
Residence
w Use of Premises
00
>011096 Linda Vista Dr.
H 3 Owner K. Evans Address
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� z By COAST WATER SOFTENER CO. Address 807 THE ALAi�1EDA
n CONTRACTOR,AGENT
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— m Phon
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u I State License ��_3 g6L-3 Approved
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_U PLUMBING INSPECTOR
FIXTURES M EMAIN DRAIN
UNITS FEES UNITS FEES
Warer 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 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 Traps TOTAL FEES
Urinals Fixture Fee i
Area Drains Main Drain Fee
Wrater Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough.,
Rough. Complete..
.Main Drain
Final...