NO PERMIT NUMBER (2) as 3 G �/``CIE�« /v �o
OT NO.
NO. STR F.F.t'
N �?PPLI�1O FOR PLUMBING PERMIT
a OP CUPERTINO
z —
x ° JUV
K 2 1966 San i[a rt' An.
Y
(Ir LL
0 U 1) / 1962 Permit No
T nF rII �{� I�(� �2
LL �pIca i 2'f�SPrlfydANG Fee Sot/
� ° p �caho s h y City 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
> I 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.
a LL Use of Premises
O O
r3 Owner Address
o a
zJ /
zBy inf/�uuk_ /,0//-?G /� �i — Address / - AU'
3 CONTRACTOR, AGENT
— Phone. 77 ;2/3 S5A, fc
. Z
w
aR a /7 � //ZL Approved
o State License
U 1 PLUMBING INSPECTOR �/
1. RNUMBER
UNITS FEES UNITS FEES
Water Heatc Size
Water Closets a Material
Hath Tubs To Curb
Showers To Prop. Line
LavatoriesTo Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals i
WaA Trays / STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink -Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material`//U
San Traps TOTAL FEES
Urinals Fixture Fee E
Area Drains Main Drain Fee
ITater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee �- v
TOTAL I II TOTAL FEE �'
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .