51122 /'X I "'i LOT NO.
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�PPLICA ION FOR PLUMBING PERMIT
< UITY OF CUPERTINO
xo /JAN /1/91966 Sanitary No.
3 u
Date./ — / J — 196� Permit No
LL CITY OF CUPERTINO Fee s 0 0
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o < 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
a m Cupertino, and a1)-(-)MNlaws applicab reto.
v
Use of Premises
3 Own O Addr ss1�/ 3
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� z By Address��/
O CONTRACTFEAGENT
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ao State License Approved
—0�I� �' f1 PLUMBING INSPECTOR , /
( r Ia —N V
111XIURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To C
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
F`oor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rings Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
-pr,.Llcr Valves Water SyS. Fee
Permit Fee
TOTAL TOTAL FEE
R CORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final