100045 6 /
I AldU ✓ LOT NO.
NO. F16NFOR PLUMBING PERMIT
f
z ` D ITY OF CUPERTINO
IJUL 22 1965
y o Sanitary No.
C 4 /r
3 ��I "/, PERTINO 196 Permit No. �/o O
T Fee S 7
O Application is hereby made to the City of Cupertino for a permit to install Plumbing
o < 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.
w x
0 W Use of Premises
Vo u5
o < Owner Address
=J
o By Address
3 F CON�ITR , AGENT
Phone, 7 U/
W Z —�/,
a o State License 07 a'�(�7�;�7 Approved W1LLLr.I.1 D. HENEVICH
U PLUMBING INSPECTOR
FIX I URESJt
UNITS I FEES r UNITS FEES
Water Heete 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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee' '
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler Valves Water-Sys. Fee
Permit Fee ' --
TOTAL TOTAL FEE c-r-TL
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\lain Drain
Final