51064 (3) / LOT NO.
E.l'
AP_PLICATInNFOR PLUMBING PERMIT
z < SOC i 5 1965 ( OP CUPERTINO
z Z
w
x 0 Sanitary \o.
a
3 a I)at r — X06',! Permit No
U Fee S
W LL
Z O
Application is hereby made to the Cit}' 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
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City- of
a w Cupertino, and all oth° � applicable thereto.
w x _
< r ��C�/1 d L�
W Use of Premises
00
3
0 Owner �7� ��Qf�/P Cy Address /�/Z / �92 L-�i�
J
a pY_ �CG f/S 7 C (/ Address S� S
O CON TRACTOR, AGENT
3 �
— `m Phone Gsh S-71
w Z
0 2 State License Approv
— 7 PLUMBINkINSPECTIOI,/
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
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinal /dU Fixture Fee
Area Drains Main Drain Fee
.VVat eaders Storm Drain Fee
5p ,TJ6s , L}, Water Sys. Fee /
Permit Fee CL
TOTAL I I I TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final