NO PERMIT NUMBER �O3C 7 / ,,yOJO CNALL ��y� LOT.NO.
No. STREET -
APPLICATION FOR PLUMBING PERMIT
TZCITY OF CUPERTINO
f1 Sanitary No.
¢ c °1
Y O I J
0 a Date 1 /� 196 Permit No
W � I U t 8 1967
� � Fee$ a 9, �o
= LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o - pipesrapd#r fixtbres-ilisted-onTthelreverse side hereof, and agrees to install said prices
iuN and/oi'�fixtures'in alcor°°dancA4,itk-i9e provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w i
� r
LL Use of Premises
00 n
3 Owner ®/�1� /�l/o�f Address
_ �,�0
0 By Address
3 F CONTRACTOR,AGENT
— Phone a 9 3
w z
¢ LL a3fr 5'3T WILLIAM D. EENMCH
0 o State Licenses Approved
-U PLUMBING INSPECTOR
141XTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size ^
Water C osets Material C,
Bath Tubs To Curb
Showers To Prop. Line v
Lavatories s To Existing
Kitchen Sinks 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 s Trays To Curb
Dental Units /
Drin ing Fountains
door Drains WATER SYSTEM
Hoppers ze ^
Restaurant Sinks Material (,�,"t/
an raps TOTAL FEES
Urinals Fixture Fee ,-0
Tr ea Urains Mai Drain Fee ,r 00
Water-Leaders .n Fee S-0
Sprinkler Valves Water Sys. Fee
Permit Fee "0
TOTAL TOTAL FEE e99, ,r0
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Hain Drain
Final...