51001.3 (2) /o a77- 1/ c Y CP COT NO.
No I e
OR PLUMBING PERMIT
P a C T�F CUPERTINO
W FEB 2]. 1968 SanitaryNu. S� 3
y O
o a Daze IQA Permit No. 5 O J
LL OF CU°ERTI^.0 Fee S
O Application is hereby made to the City of Cupertino for a permit to install plumbing
`opipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
> 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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� r
LL Use of Premises
00
>J m
c�
> 3 Owner Address
'„ / Addressi By c�
it/�G/i/r C!ri�eJY�rlr'.A
—
CONTRACTOR,AGENT
m Phone %-)9 "
0o State License /�3J� Approved
-U A, PLUMBING INSPECTOR �/
FIXtOng'-- NU BER MAIN DRAIN
UNITS FEFS UNITS FEES
Water Heate Size • -f-"
Water Closets Material C, 1,
Bath Tubs To Cu
Showers To Prop. Line )C
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
X ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks j To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER.SYSTEM
oppers Size /,
Restaurant Sinks Material
Sand raps TOTAL FEES
nna Fs Fixture Fee .pp
rea Drains Main Drain Fee ,po
Yater Leaders Stlg= Fee .,Sp
Sprinkler ValvesWater Sys. Fee ,-0
Permit Fee .o-0
TOTAL /y TOTALFEE p
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
.lain Drain
Final...