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APPLICAT FOR PLUMBING PERMIT
" a (JUL 9 1965 Fv OF CUPERTINO
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0 / Sanitary
No. /y J d
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< I) 196_ Permit No
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X LL Fee $
0 Application is hereby made to the City of Cupertino for a permit to install plumbing j
'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 applicable thereto.
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LL Use of Premises _ _ g V/
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oa Owner YAddcess! Q S`f-5'
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o By Address
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— `0 Phone �� 3 0i 0
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0 s State Licensee
Approve*
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rovUMBING INSPECTOR
FIX URES J
UNITS FEES UNITS FEES
Water Heate Size Of
Wate; Closets Material r7
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
Com . Sink-,, Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Pee o
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee p O
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Hain Drain
Final