51064 J-PI oe6oI1 r ( tl L 'i LOT NO. W
o p
jrAPPLIC N FOR PLUMBING PERMIT
S EP 3 1965 TY OF CUPERTINO
leTINO l 6
D2fF 1� Permit No.� b
CITV 60
Fee $ \.
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
�L Use of PremisesESi ti
Owner �� ` • Address
BV6jd11& Address? , 81 yd
C N CTOR AGENT
Phone 96-7- i4 S 4 _ Approved
PLU BING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES I UNITS FEES
Water Heater I Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners I ( I Material I j
Bar Sinks I 1 II To Main Drain I
Comb. Sink x Trays) To Curb _
Dental Units I =
Drinking Fountains) III
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals-1 Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives I I Water Sys. Fee
II Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final