51043.1 (8) O LOT NO. �i
APPLICATIO ; FOR PLUMBING PERMIT
z (MAY 6 1968 C 1_OF CUPERTINO
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rc LL 3 p�I�Date v D E� II f Permit No �0 3./
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i LL Fee $ 7"t
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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3 Owner_�� q�*+. ddress
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z By Address
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CONTRACTOR, AGENT
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Phone
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u s State License / S �- I �' ✓t Approved °r-- -'•F•%+1 I)
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lj_ PLUMBING INSPECTOR
I. I URES 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.
Dish Washers Sewer Boxes
Waste Disposals
\ ash Trays STORM DRAINAGE
Washing Machines Size
Water &afteners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
oppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Unna s Fixture Fee
rea rains Main Drain Fee S ,J-c
W\/ater 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