51027.7 (7) of D /CSN z Lo LOT NO.
NO. STREF.a'
jdaa,,13,1� CATION FOR PLUMBING PERMIT
CITY-OF CUPERTINO
E /MAY -4 * Sanitary \o.
M LL / �5
o j Date 1965'2 Permit No 0�7. 7
(3'j�<i
`R LY Q ��; F Fee $ �'
fpph'c.Pi nit, nide to the City of Cupertino for a permit to install plumbing
a a 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.
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< Use of Premises And, i4 �-
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wl .P/ sS � A
niv Address ;I-03`Y
o a Owner C r
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o By / P / ict i✓I/3�/YG Address �G � �?�Gn.Lnrfti�Sryb II
CONTRACTOR, AGENT
- z Phone 3
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a o e-
State License o c 24K R Approved
U^� PLUMBING INSPECTOR
141XTURES NUMBER MAIN MIR'
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material 0 /,
Bath Tubs To Curb
Showers To Prop. Line
Lavatories —' To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposa s
Wagh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material
San raps TOTAL FEES
nna s Fixture Fee
rea Drains Main Drain Fee
hater Leaders Storm Drain Fee
;pr.kler valves Water Sys. Fee
Permit ee
TOTAL TOTALFFEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final