51028 LOT No. -I
TRE T
r /YPP�f '91 FOR PLUMBING PERMIT
z 1 OF CUPERTINO
ro .'MAY 2 0 1965 Sanitary No. _
a Date / — U6� Permit No
3 LL . �J Fee
= 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
i N and/or fixtures in accord ce with the provisions of the Plumbing Code of the City of
w Cupertino, and all of r� applicable th eto./)
n Use of Premises
00 Addressq�OQ G
1 N
3 Owne it
i�
B Addre � ,//1 /Vl
J O % CONTRACTOW .
R ATi!#J'r
Pno
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,State LicenS;'� Approved
U t[+� PLUMBING INSPECTOR
UNITS FEES UNITS FEES
Water Heate Size
Water C Fsets Material
Bath Tubs To Cur
Showe To Prop. Line
LzvatorksTo Existing
Kitchen 'SinksNot Conn.
is Washers Sewer Boxes
riteisposals
ash Trays STORM DRAINAGE
Wasing Machines C Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
f' oor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand raps TOTAL FEES
nna s Fixture Fee
rea rains Main Drain Fee
t/�Leaders Storm Drain Fee
7-prinkler Valves
Water $y5. Fee
c Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
34ain Drain
Final... -'