51064 (3) IF 1624
io3a�
OT NO.
NO. STREF.I'
�e T
z a FOR PLUMBING PERMIT
Y OP CUPERTINO
o VOCT 6 1965 i Sanitary No.
0 bate 196— Permit No Sx 0 G T
50`
l C0Fee $CITYica9f isD�DTJnDhe
City of Cupertino for a permit to install plumbing
0 a 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
a w Cupertino, and all other laws applicable thereto.
a Use of Premises �-
00
o a Owner ,�/' //�(�G/� Address p3�� �
zj
J , ,, Ar/ OtAX7 4!� Address SJJ �� 7 S7
O NTRACTOR, AGENT
— m Phone C�71i J
W , / )
a a
a �-5al 1{ Approved roved e� )01
o State Licence ,/ -cl-�-�
U ^I PLUMBING INSPECTOR /�
IlIx I URESNUMBER
UNITS FEES UNITS FEES
Water Heatc Size
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
"r(/asl-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area grains Main Drain Fee
� ad er &"a Storm Drain Fee
Sprinkler Valves Water Sys. Fee
/M Permit ee
F
T TAL TOTALFEE _
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
-lain Drain
Find