NO PERMIT NUMBER (5) 11127 Linda Vista Drive 169
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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wi CITY OF CUPERTINO
' X Sanitary No.
¢ LL
03 Date OCT 71964— 196— Permit No
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iFee $ i00
0 Application is hereby made to the City of Cupertino for a permit to ins)all plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and all other laws applicable thereto.
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Use of Premises
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o Owner Crump
Address Ph n aae f G--ujg rt no
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z By CROWLH CO Address 855 Jackson Mt View
O CONTRACTOR, AGENT
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— 0 Phone YO 7-5578
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State License/ 6 � 99 Approved
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—U PLUMBING INSPECTOR
FIXTURES NUIN 13ER MAIN DRAIN
UNITS FEES UNITS F ES
Water Heate Size Do
Water ClosetsMateri
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
WAs'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WAT SYSTEM
Hoppers Size
Restaurant Sinks Material r�C,
San Traps TOTAL FEES
Urinals Fixture Fee
y',r.ea Drains Main Drain Fee OO
W ateC Leaders Storm Drain Fee
�prinklcr Valvcs Water Sys. Fee
Permit Fee O
TOTAL TOTAL FEE
RFICORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...