51145 (2) as 7 5 1 ,�z LOT No.
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® F.P C ON FOR PLUMBING PERMIT
_ CITY OF CUPERTINO
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Y p /~uY - '7 1966 Sanitary No.w _
o aUate July 27 1966L Permit No 234281
w LL CITY OF CUPERTINO Fee S 4.00
' 0 Application is hereby made 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
¢w Cupertino, and all other laws applicable thereto.
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W Use of Premises HOUSEHOLD _ INSTALLED
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� 3 Owner CHARLES E. PHILLIPS Address 21575 Monrovia st.
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z By SOFTMASTER, INC. Address 1150 DELL AVE. , CAMPBELL
CONTRACTOR, AGENT
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- m Phone 379-5050
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W W
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a a State License Approved
PLUMBING INSPECTOR
FIX I URFSNUMBER
UNITS FEES UNITS FEES
Water Ficatc 11 Size
Wate; Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners pQ Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
VV/ater Leaders Storm Drain Fee
Jprinklcr Valves Water Sys. Fee /.o o
Permit Fee : .
TOTAL TOTAL FEE d
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final