51039 '7 I (/ 1�- -tx-i-.I/ v'`^�'^C. LOT NO.
NO, STREET
APPLICATION FOR PLUMBING PERMIT
i �'���ti-7 CITY OF CUPERTINO
I1 �
r o � i � __, �. ._� ___'� 1 Sanitary No.
LL
o j Date/ � n nn L.; 196.7 Permit No O c -9
3U n, is u , IJUI
iLLFee S -
LL 0 Appli;ation.is hereby made to the City of Cupertino for a permit to install plumbing
0 a pipes;and%o 1C.Ixtutes' dlsted�on'fh>reverse side hereof, and. agrees to install said prices
r and/or fixtures inaccordance w,th the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
w x ,
Use of Premises -
00 Q ,,J
i- 3 Owner \ �[ Address-
0B"O wl
2 z WATER B FTEN�a REACI�(CLs
O CONTRACTOR, AGENT
3 F 1775 SO. Isr STREET
— W Phone 4 1` �7�7-� BAN JOSE, CALIFORNIA ..
a o �S!t/ate License��5,�� Approved j
-U /�_ PLOMBING INSPECTOR ,Y/
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wasp Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee'
TArea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee O
Permit Fee a•O
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Nlain Drain
Final...