51066 22481 _ Walnut Circle LOT NO.
ao 0 s e
APPLICATION FOR PLUMBING PERMIT
/N0V 28 1966 L�, CITY OF CUPERTINO /
C'II;a�e0�B1pQNr
�1' 2 195— Permit No. `� /0 (p�
G 11 VU
Fee S $3- 50
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.
Use of Premises
v
Owner A F F1 nri nti nn Address 22481 Wal nrnt Ci rnl e A
sy Culligan Water Cond Address 380 E. Evelyn SV -
Phone 736—2000
CONTRACTOR, AGENT _
Approved A��-^��� /
PLUMBWG INSPECTOR
IX RE U B MAIN DRAIN
UNITS I FEES I UNITS FEES
Water Heater I I Size
Water Closets I �� Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn. l
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a TraysTo Curb l
Dental Units �� l
Drinking Fountainsl i
Floor Drains l l 11 WATER SYSTEM
HoppersI I 11 Size I I
Restaurant Sinks Material l l
Sand Traps TOTAL FEES
Urinals I Fixture Fee
Area Drains l l ll Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves l Water Sys. Fee
Permit Fee
TOTAL l ll TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final