51043.1 (5) 0? 75 4"42s..i .s�..�. ,ll��NO.
NO. STREET
A-PPLt,C#TION FOR PLUMBING PERMIT
(f.1 OF C
Z - UPERTINO
i
x X Sanitary No.
Date rfSEP 5 1966 1962 Permit No -<-70 3'
WU Fee
° O, Tl atiGFs Itc IPERUNIE'le City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side herrn d agrees to install said rices
> and/or fixtures in accordance with the provisions th lumbing of the ty 0f
a w Cupertino, and all cr la •s a icable ther
Wx
W Use of Premis
00
3
Owner lLCf1 < y� Address
oa
z By C 01115, .%w S ,'Z!,✓ ICY? Address /SSS Lt/
O CONTRACTOR, ENT.
3 � /
N s�tirti c�,�T�
Phone 9� X07 5 _
W Z
a �j
0 s State License -•�-? 7 9 O Approv
a V PWMBING INSPECTOR
FIXTURES 11
UNITS FEESUNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Si s Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units
Drinking— ountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rtna�s — Fixture Fee Q
rea rains Main Drain Fee
V titer Leaders Storm Drain F
�prinllrr Valvcs Water $y5. F
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final