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LOT NO.
NO. STREET
�, 2t ATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
9 00/1968 Sanitary No. '5 / 3�
3 < Date 7 196`F Permit No �� 3—
W LL Fee $ /a• Sa
O Application is hereby made to the City of Cupertino for a permit'to"'install plumbing
o` pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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
Use of Premises
00
� 3 Owner � L'�-�-�u'h Address
Z By !/I/e�'^ Ud 7 Address-
0 CONTRACTOR, NT
3m Phone 9 - � 3aj
WW
�O /)
ao State License -`P/ Approved K/
PLUMBING INSPECTOR `�
FIXTURES NU.N BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate /.L Size
Water Closets -- Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing X
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
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee �A®
Area Drains Main Drain Fee
Water Leaders 'n Fee
Sprinkler Valves Water Sys. Fee
Permit Fee a,v O
TOTAL TOTAL FEE -
RECORD OF INSPECTION
Underground Rough...
Partial Rough_.
Rough. Complete-
Main Drain
Final...