NO PERMIT NUMBER (5)r �0'T•O / iv/www. ]�C.. LOT NO.
NO. STREE7'��
A' PLICATION FO PLUMBING PERMIT
I JUN 1 (CI�j8QF CUPERnNO
Date .�UN`1 z �968.r.. �9-� nPermit No.
,: I u L �C�t vl,
� Fee $ �•6�
1fb Application 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.
8 Use of Premises
Owner X. !-L-1 Address IJ01140'2 4/,a24.[�iu-�('
g� � Address ?V,) af
CONTRACTOR, AGENT
Phone ,7e-o-c) _ Approved
PLUMBING INSPECTOR
I
— FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcarct Size
Water Closets Material
Bath Tubs_. To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners �,�-p�� Material
Bar Sinks I I To Main Drain
Comb. Sink s Traysl1 11 To Curb
Dental Units I 1 11
Drinking Fountains) II
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 Vatvcs I I Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final