51145 (3) LOT NO. t • lO
NO. STF.F.
YZI P� . ON FOR PLUMBING PERMIT
° d ` L Ya j,ITY OF CUPERTINO
� ° AP22 1966
Sanitary No.
R
° Date I` R 196— Permit No
a
3 ((�� pp Fee $ v..
° CIApplila on tryWre&)RlgldGl0 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 withprove of the Plumbing Code of the City of
a w Cupertino, and all I I •s aPi. bl reto. -- ``
w = W
.. Use of P emises
00
3 Owner Address
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J z By - :' Address
° ONTOR, AGENT
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3 m Phoned �9— 7ACIACT � 'c
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oState License;✓ D �/O 7 Approved
U PLUMBING INSPECTOR ✓_�
1) RNUMBER MAINDRAIN
UNITS FEES UNITS FEES
'.Vater Heate Size
Water Closets Material C,
Hath Tubs ] To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
W asfi Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dcntal Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material AL
Sand Traps TOTAL FEES
Urinals Fixture Fee
Arca Drains Main Drain Fee
Water Leaders Storm Drain Fee -
Jprinkler vales Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final