51145 (2) LOT NO.—
NO.
n.NO. STREET'
IG'�C�1 FOR PLUMBING PERMIT
" a �i��••.i C OF
CUPF.RTINO
Z �G s 7
xLL IJAN 2 8 1966
o Sanitary N o,
o a Date 6— Permit No
3 w w
Pee 5
oAIqTV Clern p pT 1^& Y of Cupertino for permit
to
ll 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.
w S
LL Use of Premises
00 � /
3 Owner Address
0 < _
z By Address
O
3 F
CONTRA,/-'TOR, AGENT
Phone 3 1 g- v '71 i
w z
w w
¢ a
a o State License 5 t� �/O 7 Approved -�
U PLUMBING INSPECTOR
FIXTURES ABER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate / /o L Size L/
Water Closets 3 Material �L
Bath Tubs To Curb
Showers , 0 p To Prop. Liner
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers •e d Sewer Boxes
Waste Disposah
Wash Trays STORM DRAINAGE
Washing Machines e) Size
Water Softeners Material
Bar Sinks o To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size 7•
Restaurant Sinks Material
SanT Traps TOTAL FEES
Urinals Fixture Fee Z U""
Area Drains Main Drain Fee
7VXrater Leaders Storm Drain Fee
Jprinkler Valves Water Sys. Fee
Permit Fee
TOTAL / ae TOTAL FEE °L
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final