51028 (3) LOT NO. zo
NO. Q STR
® I FOR PLUMBING PERMIT
z a I OF CUPERTINO
Y 0 PR 6 1965 Sanitary No.
3 a Dat 196--5— Permit No S/e
wV
o Y OF CUPERTINO Fee $ S. 0.0
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
r and/or fixtures in accordance with t e provisions of t e Plumbing Code of the City of
i m Cupertino, and all of r laws ap abIt"Sle thereto.
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a Lo Jpf
Use of Premises
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o a � -Owne Address-2dCo
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J z By, Address 7 P,
ONTRACTOR, AGENT
– w Phon
s ate License 73 S'35Approv
ao
U PLUMBING INSPECCOR
FIX I URES
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 11 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 Traps TOTAL FEES
Urinals Fixture Fee p0
(Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Wal r Sys. Fee / , N
irl Permit Fee ,p4
TOTAL TOTAL FEE Op
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Slain Drain
Final...