51116 Q / 10 0 I �, � L� LOT NO.
NO. STREET
I ION FOR PLUMBING PERMIT
z `
ww OF CUPERTINO
r o Sanitary Nu;
o a Date f AUG - 1 1966 ME0A_ Permit No.
3 U �- Pees 67 �
W W f�f1n���1�11,,y1yMM�{{11
O f� lI�T
jlfu�itic� . h City of Cupertino for a permit to install plumbing
'o a pipes and/or AIF
t everse side hereof, and agrees to install said prices
rI and/or fixtures in accordance with th provisions of the Plumbin of the City of
a w Cupertino, and all oth laws appl ab thereto.
w x
� r
a Use of Premises
00
> N 1
0 3
Owner- CSV �- AddressC'1�t
� ob \� E. '(.
o J
, By �l t2�l�tg Address ' y �.�\•\
O CONTRACTOR,AGENT
3 `m Phone
w z
W W
aState License �' ��-� �' Approved Z
PLUMBING INSPECTOR
FIXTURES NU
UNITS FEES UNITSI FEES
Water Heate 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
Fiat Sinks To Main Drain
ComIT Sink—& Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ex-
Area Drains , p�� Main Drain Fee
VX/ater Leaders Storm Drain Fee
S.prin -Ier Valves Water Sys. Fee ,moo
4 pq Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final