51027.7 (5) OT .
Q �TR E
APpC C'ATILt�
FOR PLUMBING PERMIT
z < JAN 7 1965 OF CUPERTINO
w
r o Sanitary No.
0 a Da 196 6 Permit No J-10,:2 7.
3 WrUV n'
iLL 1 ItlO Fee $
- 0 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 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.
w i -
a LL Use of Premises
00 7 p
o < Owner_/] Cc, A /
Address �Q C -%+-�hi
Z0 _. y 1 � S �,�,,,.��
� z B /� « Address
J CONTRACTOR, AGENT
3 � Phone � '2 i '; C..�
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¢ ¢ Ste License 7 YA
Approved
U PLUMBING INSPECTOR
FIX I URES NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heare Size v
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not 'Conn.
Dish Washers Sewer Boxes
Waste Disposa s
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb
Dental Units
Drinking Fountains
F oor Drains WATER SYSTEM
Hoppers ize
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
VV—ate, -Leaders Storm Drain Fee
`pri nklcr Valves Water Sys. Fee /
Permit Fee
TOTAL L5 0V 11 TOTAL FEE , O
RECORD OF INSPECTION
Underground Rough
Partial Rough '
Rough. Complete
Main Drain
Final