51145 I -,/1C-/ ^�i�l +l�C LOT NO.
NO. Sn EEI'
pLl¢9�}TI FOR PLUMBING PERMIT
m d lj'i��►f.t�
i i 1 Oh CUPERTINO
f R Sanitary No.
3 a nate JAN 2 8 1966 gib_ Permit No
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o A�1IiFt�iot�heNPERTANOCity of Cupertino for a permit install plumbing
'o a pipes and or Ixtures listed on the reverse side hereof, and agrees to install said prices
> 1- 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
o_ o
> N
3 Owner Address
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By Address � ��O :41a C
CONTRA OR, AGEhT '
3 `m Phone l) 7%� `,'S Sr /
a o` State License Z 3 04 0`7 Approved
,/ i
U �� v PLUMBING INSPECTOR
FIXTURES NUMBER
UNITS I FEES UNITS FEES
Water Hcate / c e Size c q
Water Closets Z7 cot Material (j7-
Bath Tubs To Curb
Showers To Prop. Lin
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 'a d Sewer Boxes
Waste Disposal
as'h Trays STORM DRAINAGE
Washing Machines e r Size
Nater Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size r
Restaurant Sinks Material
San Traps• - TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee / , &-0
Permit Fee . v
TOTAL o �pu � TOTAL FEE OU
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\•Iain Drain
Final