51037 (5) 11137 ind'a Via a T1rivP LOT No. 163
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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wCITY OF CUPERTINO
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z o - Sanitary N0. �—
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0 a Dat�1j I►��(30� 196_ Permit No
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iLL Fee $ 100
° Application is hereby made to the City of Cupertino for a permit to ins all plumbing
`o a 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
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Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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3 Owner Ward Crump Address PO Bx 634 Cupertino
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z By CROWLEY CO. Address 855 Jact kann MVi
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3 CONTRACTOR, AGENT
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— 0 Phone YO 7-557$
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a o State License-/-(,, Approved
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PLUMBING INSPECTOR
FIXTURES
UNITS FEESIrl
UNITS FEES
Water Heare Size 4f I
Wate; 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 WATE YSTEM
Hoppers Size
Restaurant Sinks Material C.
San Traps TOTAL FEES
rivals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinklcr Valves Water Sys. Fee
Permit Fee PQ
TO-TAL 'I Y 11 TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...