51139 (3) 26 4 dF-3 I LOT NO.
NO. sTIt .
OR PLUMBING PERMIT
C P CUPERTINO
r ° 22 1965 Sanitary Vin.
V
o llate 196_ Permit No
a 1T nF ER NQ �^
3 Plty, �S'h 'UPT T , Pee $ �J O
0
� Ap ti m ere }�
made o t ,c It}' of Cupertino For n permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the prpeisions of the Plumbing Code of • City o
a
W Cupertino, and all other ws applica t reto.
wi
J
Use of Premises
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1 N
r 3 Owner Address
OZ J /''
z B}' 4 " v"�- Address S zG
0 C RAC OR, AGENT
3 0 P ne
w z
a State License Approve
—U
I/ _ PLUMBING INSPECTOR
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
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 s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee p O
Area Drains Iloo Main Drain Fee
tVater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /eO
/
. 00 Permit Fee
TOTAL U0 TOTAL FEE O
RECORD F INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final