51087 (2) 221 Vista Place LOT NO. 19
T1 m ION FOR PLUMBING PERMIT
< SEP 14 1965 �� Clry oP CUPERTINO
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x o Sanitary No.
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O ^ f4 196 Permit No
iLL I6ftPees
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
> 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.
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Use of Premises Residence
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, 3 Owner Franklin-Bahl Const. AddressP•O.Box 911, Campbell
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By Central Service Co. Inc. Address451 Queens Lane , S.J.
O CONTRACTOR, AGENT
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- Phone s 298-o556
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a WILLIAM D. D=NBVICH
< 0 State License Approved
u`y PLUMBING INSPECTOR
F
IX URES NUMBER
UNITS FEES UNITS FEES
r lica[c U Size Al Z.0 u
er Closets 2 ca Material (!,r-
bath Tubs f 0 To Curb
ers / cc To Prop. Line
tories 3 ; o . To Existing
en Sinks Not Conn.
Washers Sewer Boxes
e Disposals Trays STORM DRAINAGE
ing Machines /a Size
r Softeners Material
inks To Main Drain
. Sinks Trays -To Curb
al Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size I '
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /d p
Area Drains Main Drain Fee u
Water Leaders Storm Drain Fee
�prinklcr Valvcs Water Sys. Fee C
Permit Fee ,pp
TOTAL I tioOu TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .