100070 daZ LO NO.
�WO �_ �STREEi'
J APPLICATION) FOR PLUMBING PERMIT
a OITSY�OF CUPERTINO
0 JAN 24 1966 Sanitary 596 76
x o 5' No.
3 U Date I Uf UI't^��� }�96 6 Permit No l O 0.-O 70
i4 Pee $ ! �
o< Application is hereby
made to the City of Cupertino fora 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.
~ ~ S •5
J LL
Use of Premises
00
3 Owner- Address /Z�Ltiw
By 210e 4 �� r�� " `address NS%S ti. (Z
O CONTRACTOR, AGEN
3 W Phone >'5-l 2-336
wz
ww
rs3
y� z
a o State License. Approved
_ U PLOMBING INSPECTOR ✓
1�
FIXTURES UNIBLI MAIN DRAIN
UNITS FEES UNITS FEES
Water Heam Size
Ware, Close's 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
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final