NO PERMIT NUMBER (2) LOT NO. R
NO. Fd� S T
jAP_P.�l A ION FOR PLUMBING PERMIT
a hCIITY OF CUPERTINO
r o (MAY — 5 1966 �: sanitary No.
0 /
3 a Date 2B� 196 Permit No
CITY✓OF CUPERTINO Fee $ 9.
j LL
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
0 . pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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. �9
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�i2�ti f�ri �h �o9zti e
LL Use of Premises t,r� / !� �1�1�'a�/ .(Jv/.
00 �� /
0 3 Owner J'' t .0 Address
z By Address Ar
CONTICACTOR, AGENT
3 m Phone 7�G'
ao State License 7s/ Approved
U PLUMBING INSPECTOR
�J3aL
NUMBER MAIN I
UNITS I FEES UNITS FEES
Water Heate 1 /0.0 Size r(
Water Closets Material epST
bath Tubs To Curb
Showers (e To Prop. Line
Lavatories4 To Existing ✓
Kitchen Sinks spittr Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drin ing Fountains
Flax Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material (,•
an raps TOTAL FEESy',)
Urinals Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
-prinllrr Valves Water Sys. Fee
Permit Fee
TOTAL 9oZ TOTAL FEE
RECORD OF INSPECTION q C
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final