51087r 22204 McClellan Rd LOT NO,1
NO. STREE.I'
PP I TION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
xISEP 141965 Sanitary No.
3 : {)ate 5'eiit. 13 — 196 5 Permit No .5—/O tf-7
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CITY QF CUPER�TINQ Fees s
-. Apl kation a here y mat e w the City of Cupertino for a permit to install plumbing
'o a -'Pipes and/or fixtures listed ori 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 alt other laws applicable thereto.
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4 Use of Premises Rpsi r3PneP
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3 Owner Franklin Bahl Const. Address P•O.Box 911,Campbell
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; , By central SErvire CO- Address 45-L QnPPns i.anP _ J.
3 - CONTRACTOR,AGENT —�-
- < Phone 29$-0556
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a o State License 1��5� '7 ApprovedWfLL1AM D. BENEVI(`a.t
U� PLUMBING INSPECTOR L�
FIXTURES 1
UNITS FEES UNITS FEES
Water Heate I Do Sae 4 ' ;.,UO
Water Closets 7 tic Material G
Bath Tubs l b^ To Curb
Showers i.e u To Prop. Line
Lavatories g 3.0o To Existing
Kitchen Sinks 1.00 Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
Wash TraysI STORM DRAINAGE
Washing Machines 0 Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size I " u
Restaurant Sinks Material (�pL
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain pee or
titer Leaders Storm Drain Fee
-prinklcr Valves Water Sys. Fee I .j V
Permit Fee
TOTAL jp TOTAL FEE
RECORD OF INSPECTION
IF
nderground Rough
artial Rough
ough. Complete
ain Drain
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