51001.3 / LOT NO. o 7�
NO. STREE.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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3w Va
Sanitary i\u
i Permit N.
o O3ate /SEP X9 1967
Pee $
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0 Application is hereby made to the C t�y of Cupertino for a permit to install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I and/ot-OkT-u'rl's iRScc, r ai gy�,�In he'provisions of the Plumbing Code of the City of
a w Cupertin'o,'and :4111 otli sr3p��� ble thereto.
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0 LL Use of P00
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3 Owne Address_ Ft.C°'.lie�.i
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J , By Address
O CONTRACTOR, AGENT �^ G
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— 0 Phone ag?_dp77
p aYJIL_LL`.11 U. CauP:cVICH
O Y State License�2,? Approved -
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-U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heate f I 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
as Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Co . Sink % Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
ring s Fixture Fee
rea rains Main Drain Fee p
lVrater Leaders ee Y
Sprinkler Volvos Water Sys. Fee e 0
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Slain Drain
Final