2631r
2600' v eek Blvd.
LOT NO.
APPLICATIOI R PLUMBING PERMIT
W = �IMAR 5. 1964 P CUPERTINO
x o Sanitary No
3 < Datef'l IPFRPermit No. ,-;2hlJl
w LL Pee $ Z9 O�
T 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
a 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.
w x
w Use of Premises . rnmmarri aI
00
� 3 Owner Rhodes Const . Address 690 Kings Row San Jose
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� z By Winchester Plumbing Address 1217 Dell Ave. Camp
CONTRACTOR,AGENT
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- Phone 178-7615
oState License_ 210245 Approved 1�
u
n- PLUMBING INSPECTOR
FIXTURES DBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater oO Size —;7;
—
Water Closets FoD Materia'_ e j
Ra-t Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
\taste Disposals pp
Wash Traysp'V STORM DRAINAGE
Washing Machines Size
Alater Softeners Material
liar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units.
Drinking Fountains ;v I)
Floor Drains y Z,yJ WATER SYSTEM
Hoppers Size 6r1
Restaurant Sinks Material Coo C.e
San�'raps TOTAL FEES
Urinals / Fixture Fee A41 0
Area Drains Main Drain Fee --).p D
Water Leaders Storm Drain Fee
sprinkler Vmves Water Sys. Fee
Permit Fee G
TOTAL TOTAL FEE y.p0
RECORD OF INSPECTION
Underground Rough..
'.Partial Rough_ t
�.RougL Complete..
L9'Iain Drain
Final... I
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