51145 0 /Szl / LOT NO. ( ?Oz
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N �PPL1 ATIQN FOR PLUMBING PERMIT
CIITY OF CUPERTWO
r o IDEC 15 1965 Sanitary No.
R 4
o � Date 196— Permit No
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=u CITY OF. CU ff RTINO Fees f�
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' 0 Application Is here y ma e 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
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.
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a W Use of Premises
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Owner
�} COclress C.GIXfl'..�G
z By — 4 of,f Addressl/�- PJ4 d��LLI.C:fri//
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— m Phone j 74
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aR 2 3 C� 7 A e
o State License pprovd
U PLUMBING INSPECTOR
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FIXTURES NUIN, BER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heate Size
Ware, Closets 3 q,CIC Material
bath Tubs aV To Curb
Showers /r To Prop. Line
Lavatories 3,OV To Existing
Kitchen Sinks r &D Not Conn.
Dish Washers Sewer Boxes
Waste DisposalsIJV
Wash Trays STORM DRAINAGE
Washing Machines /, or Size
Water Softeners Material
Bar Sinks , OU To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material 6;or
San Traps TOTAL FEES
Urinals Fixture Fee
do
Area Drains Main Drain Fee , crd
aders
Water LeStorm Drain Fee
�I.rinklcr Valves Water Sys. Fee r O'U
Permit Fee , p'0
TOTAL Ot+11 TOTAL FEE ,.QO
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final