51145 (3) �C 7'r/ I g LOT NO.
NO. STREET
jd -QMPPLI ATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
x o �NOV - 1 i9S6 . 11 Sanitary No.
M < t October 25, 1966 Permit*No
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w LL ! Y OF CUPEkp► l 1 Fee$ -3 S�—
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• Application is hereby de t 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
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Cupertino, and all other laws applicable thereto.
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w Use of Premises HOUSEHOLD
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3 Owner MAX ODEKIRK Address 21751 SANTA BELLA PEACE
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� z By SOFTMASTER, INC. Address1150 DELL AVE. , CAMPBELL
CONTRACTOR,AGENT
3 �
Phone gZg_5n5n
a o State Licens 3 Z� Approved ��
—0 tr.� PLUMBING INSPECTOR
FIX I UREb NU 13ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Si n cs Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash-Trays STORM DRAINAGE
W- ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks rays To Curb
Dental Units _
Drin ing Fountains
iRestarant
ns WATER SYSTEM
Size
Sinks Material
TOTAL FEES
Fixture Fee s�s Main Drain Fee
ders Storm Drain Fee
alves Water Sys. Fee
Permit Fee a.o-F
TOTAL TOTAL FEE 3.s 6
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...