51027.7 (6) 0 D O LOT NO.
h0 0 = EET
N APDIVICAT -1N FOR PLUMBING PERMIT
f JAN 7 1965 or cuPPa7lrro
' o Sanitary No.
3 a Da �19616 Permit No _'��D� 70
1 � ' Pee S l0 Ofl
o 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 a` 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 1 '
Use of Premises
o 0 7
� 3 Owner 'V/5 Address ��� e/y0 /RG [� l.y/y
ZO, �h./f //
2 BY-- 5 Address
CONTRACTOR, AGENT
3 ` ni ) 9SRS
— z Phone
w z
ao State License o 9 Y6' Approved
UI PLUMBING INSPECTOR
PIXTURES NU BER MAIN DRAIN
UNITS FEES UNITS FEES
`.Vater Heatc J Size
Watel Closets MaterialCV
Bath Tubs To Curb
[Lavatories
Showers To ProLine
To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposa s
W ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drinking Fountains Ask
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an raps TOTAL FEES
finals Fixture Fee
Tea rains Main Drain Pee o-o
Water Leaders Storm Drain Fee
5pr nkler Valves Water Sys. Fee
Permit Fee
TOTAL13.W11 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final