51145 (3) 4� I LOT NO. �J 3
NO. REF.T'
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PCei%HL&TOr"N FOR PLUMBING PERMIT
fi PR Y OP CUPERTINO
r 22 1966 Sanitary No.
2 LL .moi YJ'
o j Tte 196— Permit No
3� Cir
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OF Fee $
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Application is ��te�}tMa�R�� 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
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws app cable they o.
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a Use o Premises
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0 3 Owner aul Address
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O CONTRA OR, AGENT
3 Phone `7 7- z15 �Z sC
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fi 7 e9 -rL297 Approved
—
< o State License /
—0 PLUMBING INSPECTOR !/
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I) RAC
UNITS FEES UNITS FEES
`'Vater Heate Size
W'a[er Closed Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sirdts Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wafh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material ZIAIL
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Pee
VY-ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE O
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final