100075 V�/ I / / `�t.'l�t%J��✓U..+ V-/�A..'W. LOT NO.
t" OIOR PLUMBING PERMIT
N Q
i 4 CI [' CUPF.RTINO
o f MAR 3 1966 Sanitary No.
o a Date ` 1 Permit No,
o 100, () 7S-
3 CITY OF CUPE �N o 0
w � Pee $
0
� Application is hereby made to the Cit}' of Cupertino for a permit to install 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
a w Cupertino, and all i her laws applicable hereto.
w x �
� r
J 0
Use of Premi s
o a Owner Ad ss `�
J z By Add resS/ �/
J 0
3 F C NTAACTO$ T
Phon — L,( _
¢ a 6O � / �Q `
u s Slate Lice n Approved /J 1 -�"
a o
U, I PLUMBING INSPECTOR ✓
FIXTURES NU
UNITS FEES UNITS1 FEES
Water Hexa Size
Water.Oosets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks, Not Conn.
Dish Washers Sewer Boxes
Waste.Disposals
WasWl Trays STORM DRAINAGE
Washing Machines Size
Water $ofteners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental 'Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
=—Drains
Fixture Fee /.00
Main Drain Pee
Storm Drain Fee
Water Sys. Fee , a. Q O-00 TOTAL FEE ,Q O
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final