51064r
101 a an ri pP LOT NO.
?DNo aAPPLI AJ��}7jf1� FOR PLUMBING PERMIT
, J U L 2 1965 ' OF CUPERTINO
:J;.1
JW G�
D6 �� VpE"WG1916- Permit No. �"J" +*�
Fee $_1;.n0
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.
& Use of Premises Rr-iclpnre
v
hOwner. -
1,
T-n .' a Address 10.171. Fharly; Dr.
C � /. 23—B Ypffett Blvd
gy R Address � a�� t'
80 ^ACTOR,
X67— NS�/S Approved �,
Phone PLUMBING INSPECTOR
rIXMURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Sae
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 Material
Bar Sinks Main Drain
Comb. Sink a Trays) To Curb
Dental Units
Drinking Fountains) � II � _
Floor Drains WA TLR SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I II Water Sys. Fee
Permit Fee
TOTAL TOTALFEE e
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final