51119 '�)'e 3' az I ..�jv7n� ? LOT NO.
NO. ®` ss�EJET�
6�APPLICATION FOR PLUMBING PERMIT
1' ,'TTY OF CUPERTINO
x o (DEC 21 1967 sanitary No.
o < Date 196 Permit No
W a C:TY 0I= CUPERTINO, Fee
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/ox fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
00 Use of Premises
�
3 Owner—'16� oe:14 / Address ,90 3
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� o By CJ Address
CONTRACTOR,/AGE
3 Phone ✓� '�(
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rca �y
a o State License, a2�i Approved
—U PLUMBING INSPECTO r
FIXTURES NUN, 13ER MAIN
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 +& Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water-Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...