51037 (2) 11117 Linda Vista Drive LOT NO. 170
NO. STREET
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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x o n Sanitary No.
3 < Date OCT 7 1s79�, 196_ Permit No
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Application is hereby made to the Cit of Cupertino for permit 'n
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`opipes and/or fixtures listed on the reverse side hereof, and agreesrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
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Use of Premises
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3 Owner Ward Crump Addrest " Box 634 Cupertino
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J z By CROWLEY CO Address 855 Jackson Mt Viesy
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— W Phone YO 7-5578
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a State License Approved
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PLUMBING INSPECTOR
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UNITS FEES UNIT5 ES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
. Line.
Showers To Prop
'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
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER YSTEM
Hoppers Size ,
Restaurant Sinks Material'/ C.
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTALv TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
Main Drain
Final...