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APPLICATI ' b FOR PLUMBING PERMIT
z a ?(NOV 10 1965 OF CUPERTINO
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r o Sanitary No.
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i a Fee $
o Application is hereby made to 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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises >1 r7 �'/ !/1
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3 Owner 1 W G S / Q'0 Address /0 d k,9
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CONTRACTOR, AGENT J C S
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ao State License x 7 7 Approved
— U 4 PLUMBING INSPECTOR
F IXI URES
UNITS FEES UNITS FEES
Water Heate Size t-�-
Water Closets Material C,
Bath Tubs To Curb
Showers To Prop. Line ✓
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee 2 �°
eater Leaders Storm Drain Fee
Spdollcr Vales Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final