51133 (2) 1022i I Vicksburg, Cupartinb�LOTNO.
SnEET
No. APPLIGrAMIQN, FOR PLUMBING PERMIT
d C TYOOF CUPERTINO
0 o I (fMAY �,4 1965 Sanitary No.
0 a Date '�— 6— Permit No. r//// .3 3
3 LL Fee $
Apoatyon Q[er fpTHIity
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
1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
LL Use of Premises Family Dwelling
00
3 Owner John Kohfeld Address
0a
zz By Softmaster, Inc . Address 1150 Dell Ave Camp .
J o CONTRACTOR, AGENT
3 �
- m Phone 79-5Q50
W z
f a
U to Licens 123403 Approved
a 0 \
PLUMBING INSPECTOR
FIXTURES NUN, BER —RTTITnRAIN
AUNITS FEES UNITS FEES
Watep Heate Size
W .r Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sin Not Conn.
Dish Washers Sewer Boxes
ante Dlsposa s
ash Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners Material
Bat Sinks To Main Drain
Com . Sin s _ rays To Curb
r
Dental Units
Drinki:rg Fountains
Floor,Drains - WATER.SYSTEM
Hop;ers Size
Restaurant Sinks Material
an raps TOTAL FEES
rivals Fixture Fee 4�'O
rea rams Main Drain Fee
Water Leaders —Storm Drain Fee
Sprinkler Valves Water Sys. Fee /
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough-
Rough Complete..
Main Drain
Final._