51145 (4) LOT NO. O
NO. STHEF.T
APPLICATION FOR PLUMBING PERMIT
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.z i b � �ITY OF CUPIiRTINO
o Sanitary No.
o 1) Pd 196J Permit No
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30 $ �
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° A i ati s e City oC Cupertino for a permit to install plumbing
o pi�rt�d/ xt�� ���reverse side hereof, and agrees to install said prices
> and or fixtures m accor a8ce with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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Use of Premises
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,- 3: Own r Address
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zCR PLUMBING Co.
J z g}. CROWN PLUMBING CG1„Ei6. Address
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° T..�7`16RR86�2` P. O. Box 802
- 0 Phone Saratngn CeIltfereia 14aratoga. California
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a o State License Approved /
U� / PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNrrsj EES
Water Heate Size
Water Closets Material C.T_
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
Water So teners Material
Bar Sinks To Main Drain
Comb. Sink v Trays To Curb
Dental Units
Drin ing Fountains
Moor Drains WATER SYSTEM
Hoppers ize
Restaurant Sinks Material
San Traps TOTAL FEES
Urtna s Fixture Fee lo.00
rea U,ains Main Drain Fee
W-ater Leaders Storm Drain Fee
Spnnk]er valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE s
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final