51037 II �� Rn.
FAUG
APPLICATr�IL FOR PLUMBING PERMIT
2 5 1965 ( Y OF CUPERTINO
w �
x o � Sanit-.iry No.
0 LL �'/O 3
D�'j196_ Permit No
3 `
U
i LL Pee $
` 0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i I and/or fixtures in accordance with the provisions of the Plumbing Co the C y of
w Cupertino, an 1 all I th laws app I- le hereto.
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Use of Premis
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CONTRACTOR, AGENT
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a a t State License Approve
U 1 ' , PLUMBING INSPECTOR (/
FIX I URES NUIN 13ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Neate 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
Bac Sinks To Main Drain
Com . Sink m Trays To Curb
. / _
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee Q
Area Drains Main Drain Fee
i
\Water Leaders Storm Drain Fee
�prinklcr valves Water Sys. Fee
iV'jj-S" Permit Fee , pp
TOTAL TOTAL FEE �O
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final