51043.1 (3) -IO 6 _ LOT NO.
NO. /
Nn. STREET
N F R„PLUMBING PERMIT
a CITY FCUPLRTINO
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p ,MAY 6 u _
x a 1968 s:mitary inn.
3 a Date 196 a Permit No. .S /�' `7`7 3_ i
U S
o !NT`/ OF CIJPFRT '0 Pee
Application`is hereby mar to the ity 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 prKes
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other lases applicable thereto.
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0 LL Use of Premises
00
3 Owner `R GL F ;? Address
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z By 15c -:e Address n5'4-A <. ly
O CONTRACTOR, AGENT
— `m Phone !/
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Q a WILLIAM D. EIZN MVICH
a o tate License �l1 Z IGT Approved
U PLUMBING INSPECTOR /
1
I11X I URES NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
ESi
ate Size
Waterlosets Material
s To Cur
To Prop. Line
To Existing
inks Not Conn.
shersSewer Boxes
sposals
as Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
7-print9cr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final