51043.1 (11) ,a 9-0 0- / - 4, LOT NO.
NO. �
PLUMBING PERMIT
< ® CITY OF�'CUPERTINO
f
z o !MAY 6 1968 `�� sanitary No.
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3 a Dates 1963 Permit No
CITY OF CUPERTINO Fee 7�
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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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J 4
Use of Premises
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3 Owner Address
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o By 14= 1.6. e eO Address d, S'j rS Ape
3 F CONTRACTOR, AGENT
Phone Z S(o 2-S�
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a a State License / 1—/ 4 S Approved -
_ U PLUMBING INSPECTOR /
FIX I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Watcr Hearn Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Dislwsa s
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers ize
Restaurant Sinks Material
an raps TOTAL FEES
Urinals jj Fixture Fee
re-Drams Main Drain Fee ,S'rll
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee ,� ✓v
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final