51145 n0. s Lor N0.
T FOR PLUMBING PERMIT
i `- OF CUPERTINO
LWJAN 28 1966y
x o sanitary \o.
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0 a Date 196_ Permit No - ,
3 CITY OF CUPERTINO
w a Fee $
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Application is hereby made to the 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws cable thereto.
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a .. Use of Premises
00
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r 3 Owner Address
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o By C.�y's-ac�+ /�'7 L' - Address gj . d
3 CONTR OR, AGENT
- . Phone 3
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a o State License 1 �-' c/e2 Approved /�' ✓-%� . .i
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—U� PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size q el
Water Closets Ot Material
Bath Tubs j n s, To Curb
Shower; To Prop. Line
Lavatories 0 6, To Existing
Kitchen Sinks Not Conn.
Dish Washers >J Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines o g Size
Water Softeners Material
Bar Sinks t To Main Drain
Comb. Sink'd'Trays To Curb
Dental Units
Drinking Fountains AML
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /0. vv
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
�pdnkler Valves Water Sys. Fee ori
Permit Fee pv
TOTAL TOTAL FEE a_a
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final