51043.1 (7) ab I LOT NO. e
NO. EF.
D
LOR PLUMBING PERMIT
a CI I„ P CUPERTINO
xo MAY 6 1968 kU Sanitary No.
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Date 196Q Permit No5-10 /
3 LLCITY OF CUPERTINO Fee $ 7
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
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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a Use of Premises
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pJ Owner // !F 9LW Address
J a By zt� Address /S/rT-
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3 CONTRACTOR, AGENT
- W Phone-2 T-y-d
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a a State License Approved VVILLIAtIj
4 PLUMBING INSPECTOR
FIX I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Har Sinks To Main Drain
Com . Sink Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers ze
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
rea Urains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler VaI,,s Water Sys. Fee
Permit Fee ..r.
TOTAL TOTAL FEE 7o=
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final