51043.1 (4) Zd0!J o a-ax LOT NO. r
Nn. STIIEET
PLUMBING PERMIT
z `- , T F I UPERTINO
x o MAY 6 1968 sanitary. No.
Q4
o a Date C196 Permit No 6--/o
W LL CITY OF ClippT�rd(� Pee $ 7
x
' o Application is hereby ma e to to ty f 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
> 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
� r
Use of Premises
00 /
0 w
Owner �t �.,/Address
r 3
z J /�_ �m
z By /0 Ls��J~(�v Address 5/ SS
O CONTRACTOR, AGENT
3 r
Phone
R u
a State License
�.] ST'`d Approve,WILLIAM D. RENEVICH
o —
- U .� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing '
Kitchen Sinks Not Conn.
D's Washers Sewer Boxes
Waste Disposals
as'h Trays STOR DRAINAGE
Was ing Machines Size
Water Softeners Material `
Bar Sinks To Main Drain
Com . Sin -Trays To Curb
Dental Units
Drin ing Fountains
FTo—or—Drams WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
rea rains Main Drain Fee o_.
'Water Leaders Storm Drain Fee
�prinkler Valves Water Sys. Fee
Permit Fee o2
TOTAL TOTAL FEE 7e �
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final