51027.7 (3) OG o -,/ ad � LOT NO.
NO. STR
?(FEBPLUMBING PERMIT
z < 1 OF CUPERTINO
x a ' S 15 1966 sanitary No.
a _
o w Date 196G Permit No 7
3 <
CITY OF UPERTINO Fee S-7
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� Application is hereby, made to the City of Cupertino for a permit In install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I 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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a Use of Premises fF/ e- -P
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0 3< Owner .*._Mn A N Address a o ([3,o TO t A/ � �
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o By Q�/�oS/ '� y1y ,elWc Address a'+)-Ir'
3 F CONTRACTOR, AGENT �Ay� �9M�/9♦ (.L
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o State Licens �'�^ Approve
PLUMBING INSPECTOR 1/
NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Si Not Conn.
ish Washers Sewer Boxes
Waste Disposals
WA—ST; Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sins To Main Drain
Comb. Sinks Trays To Curb
Dental Units
Drinking Fountains
P oor Drains WATER SYSTEM
uppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Unna s Fixture Fee v It
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinklrr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE 00
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'.Main Drain
Final