NO PERMIT NUMBER (3) i
OT NO.
NO. STN F,F.I'
PLICATION FOR PLUMBING PERMIT
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ITY OF CUPERTINO
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z o Sanitary No.
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o Da �� I, 1966 Permit No
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w u Fee $ 42
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° i�ic t�rt I d¢1f the City of Cupertino for a permit to install plumbing
`o < pipes andor fix On t�re reverse side hereof, and agrees to install said prices
> and/or fixtures In accordance with the provisions of the Plumbing Code of the City ofI
a w Cupertino, and all other laws applicable thereto. Alw* e--C—,
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� 1C'Z.W--20975 &Z441J . .
0 LL Use of Premises
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oa Owner 6`p �Ji21r� Address�3l/,t &,4L, &z. —( Ae,,,6,
J zBy ;�I.�/ �FKC.�[.. - . Address
3 O CON CTOR, AGENT
— Phone
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° State License Approved
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PLUMBING INSPECTOR
7'Oy
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closcts Material
bath Tohs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drinking Fountains
Flax Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material ,q(,
San raps TOTAL FEES
nna s Fixture Fee 6
rea rains Main Drain Pee-
Water Leaden Storm Drain Fee
Sprinkler Valves Water Sys. Fee d-4'
Permit Fee v ;,7.0 0
TOTAL TOTAL FEE
—
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final