51145 LOT NO. .9l 3
NO. sTREEi'
f�Pl�Fp ON FOR PLUMBING PERMIT
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x o i Sanitary No.
3a ,,, fJAN281966 196_ Permit No
U Fee $
° (NTYcatoFis r TjWe City, of Cupertino for a permit to install plumbing
o a pipes and/or fixtures lisle on tic reverse side hereof, and agrees to install said prices
> r 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.
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.. Use of Premises
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r 3 Owner_.(/ �' Address /1
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3 F CONTRAC R, AGENT
- W Phone 37 i-
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o f State License 2 0 yD J Approved i
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U I PLUMBING INSPECTOR V
FIXTURES D 13ER MAIN DRAIN
UNITS FEES UNITS FEES
`JVatcr Heate / D
Size "
Water Closets - p J Material
bath Tubs v�� To Curb
Showers .I To Prop. Liner
Lavatories oD To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines o 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 p
San Traps TOTAL FEES
Urinals Fixture Fee p,
Area Drains Main Drain Fee 2, CID
Wiater Leaders Storm Drain Fee
.prinkler valves Water Sys. Fee rr0
Permit Fee "2_ c
TOTAL o a.v e TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final .