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O LOT NO. 4ft /o
N . SSTRE.F
AV
N �-�A�PPPPLI -�ATION FOR PLUMBING PERMIT
a a 1� CITY OF CUPERTINO
= 9 /MAY 5 1 66 tl sanitary No.
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9R
MAY 6
o < Date � ��� 196— Permit No,
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���00L Un �(JnF p n r/�Icc
"fly Application s'11��f}1lae to the City of Cupertino for a permit to install Plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
r , and/or fixtures in accordance with the provisions of the Plumbing Code of the C ty of
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Cupertino, and all/other laws applicable thereto. 41100 4 Af)
Use of Premises�/ i ��O 'S �v O
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00 3 Owner Address4el� 644—.
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o By Address W i» 6l �z
O CON�'RACCOR, AGENT
Phone
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yJk State License Approved
PLUMBING INSPECTOR
,�O 1
FIXTURES
UNITS FEES UNrrsj FEES
Water Heate /.p,0 size
Water Closets Material C q�f
Bath Tubs •ot, To Cur
Showers �. To Prop. Line
Lavatories To Existing a
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\TVash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Si s rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material ,g
San raps TOTAL FEES
Urinals Fixture Fee ,OD
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
prinLler Valves Water Sys. Fee Q—ZI
Permit Fee oj,Z-p
TOTAL TOTAL FEE
RECORD OF INSPECTION 71 _3
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .