51037 LOT NO.
EF.
PLICA O OR PLUMBING PERMIT
z F CUPERTINO
(JUN 11 1965
' M Sanitary No.
3 a Date ��-6 Permit No o
U Ulf
Fee $
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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all laws applicable her
wx o
Use of remises
00 u
3 (72
Z
J z B Addres /
3 < CONTRACT R, AGgENT
— H Phon I/L /
Y State Lice"?ay
o Approved
a
-0 PLUMBING INSPECTOR
141XTURES NUN BER MAIN
UNITS FEES UNITS FEES
',Vater Heate Size
iter Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners "' Material
Bar Sinks To Main Drain
Com . Sink b Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee'
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
5prinklrr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...