51039 /0 PXA,L X� A YI LOT NO.
NO.
r o G
I FOR PLUMBING PERMIT
or
CUPERTINO
® JAN
18 1965 Sanitary No. p
3 a Date December 23 lqd� Permit No J7999-9
CITY OF CUPERTINO Fee $ 4.00
o Application is hereby made to the City 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Ln
Cupertino, and all other laws applicable thereto.
w x
w Use of Premises HOUSEHOLD
o_ o
> N
� 3 Owner Paul Schwab Address 10401 Phar L,- D-
oa
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z By s e r c. Address P6 7W ALAAfEA-
O CONTRACTOR, GENT
3 �
- a Phone a9S-s'i9S
aState License /.2syor —?I Approved
PLIIMHING INSPECTOR
FIXTURES NUM I DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Mateca!
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners 1,Qo Material
Bar Sinks To Main Drain
Comb. Sink &_Trays ,y To Curb
Dental Units
Drinking FountSins Adlbk
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks ' - Material
San Traps TOTAL FEES
Urinals Fixture Fee ,��O
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaivcs Water Sys. Fee /, 19
Permit Fee a
TOTAL TOTAL FEE z/.00
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
Main Drain
Final...