51122 /0 3,5--571 o2 oto �t� 7 LOT NO.
NO.
APPL�ICAT,IQ�FOR .PLUMBING PERMIT
z a CITY O ,PF.RTINO
x o JUL 22 1968 Sanitary No.
¢ /i Z Z
0 Uate 196 Permit No
3�
w CITY OF CUPERTINO Fee $ 3 5Z
1 LL
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 rices
> 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
LL Use of Premises
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3 caner Z' Address
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z By � [�/iY�c-�-e+ter rr,� Address 75'4
CONTRACTOR, AGENT
3 �
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One o? S 7— s /CJ 7
ate License 3 7 i D � Approved
PLUMBING INSPECTOR
Pix i U"S NUN, BER MAIN DRAIN
UNITS FEES UNITS FEES
'Water Heate Size
Water Closets Material
Bath Tubs To Cur
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 . S,-T Tyr ays To Curb
Dental Units
Drinking Fountains
I oor Drains WATER SYSTEM
Hoppers ize
Restaurant Sinks erial
an raps i TOTAL FEES
nna s I Fixture Fee I
rea rains ain Drain Fee
�iUater Leaders V Otorm Drain Fee
Sprink�or Hos Water Sys. Fee
Permit Fee ,
TOTALV TOTAL FEE 3• SD
R COftq OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
J4ain _Dr
Final ain 72y7