51001.2 LOT NO.
iSTREET 7-
APPLICATION FOR PLUMBING PERMIT
(SEP )5 1966 CITY OF CUPERTINO
Dat 1967 195_ Permit No.
Fee $ :IT —TV
QApplication is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
'4
Owner%c. C AddressAQ,529G�Jt /l!v
B Addres -5rQ(FC� /n—
CONTR =R, AGENT
{ Phone 6— Approved��• 1
F PLUMBM INSP��
FIXTURES NUMBER MAIN DR IN
I UNITS I FEES 11 IUNrrsl FEES
Water Heater Site
Water Closets �� Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories I To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size l
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb
Dental Units
Drinking Fountainsl l ll l
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves � l I Water Sys. Fee
H Permit Fee
TOTAL l L ,tet()jl TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final