51145 LOT NO.
NO. sTNEEI'
N < �AP.PLI�ANTIO.N FOR PLUMBING PERMIT
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® CX OF CUPERTINO
° (DEC 15 1965 sanitary vn.
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° < Date , 196— Permit No
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U T Fee $
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° �'�plitoti0fis tfJW,, E JTIN0, 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 m 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,
LL Use of Premises � ��.�A el
of
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3 Owner /j� �1� ess
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By vT - �ry ' Addres�� �O:Z
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Phone
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a((((o���� State License / Approved
PLUMBING INSPECTOR
11 I. R hS
UNITS FEES r UNITS FEES
Water Heate /• 0' Size (.f
Water Closets , e'v Material
bath Tubs , co To Curb
Showers /. 0 To Prop. Line
Lavatories j,Ve To Existing
.Kitchen Sinks 1 Not Conn.
Dish Washers .o--1 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines r [Jo Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material Coo'
San Traps TOTAL FEES
Urinals Fixture Fee r
aArea Drains Main Drain Fee ,
`Vater Leaders Storm Drain Fee
7-pdokler vales Water Sys. Fee
Permit Fee . ( -
TOTAL TOTAL FEE
RECOR15 OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final