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APPLIPATIQN FOR PLUMBING PERMIT
a ® 1�ci�TITY OF CUPERTINO
w IDEC - 6 1966 .' S:mitary No. _
fn
xLL // 7
o � Date- 1961 Pcrmit No 3 /O � 7
4 CITY OF CUP RTINO Fee s /,z
0 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 accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other Taws applicable thereto.
a Use of Premises
00
> N
3 Owner�C�'LAl[-oir�-..��, Address 51-0 `f }� �-",+�
z B� Address <
y CONTRACTOR, AGENT
- m Phone
0 2
a s State License S l y Approved
PLUMBING INSPECTOR
r 1
UNITS FEES UNITS FEES
Water Hcate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Lief
Lavatories To Existin
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sinks Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
oF� ppers Size
Restaurant Sinks Material
an raps TOTAL FEES
rings Fixture Fee O
rea rains Main Drain Fee
Nater Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee
Permit Fee O
TOTAL TOTAL FEE J a o
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Completr
Main Drain
Final