51104 (3) J!W/ K/ 'z rel./ LOT NO. ,
No. TA
OR PLUMBING PERMIT
a OF CUPERTINO
f 0 Ff
' 0 EB 1. 5 1966 Sanitary No.
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0 a Date 196— Permit No r1l O V
=4CITY OF CUPERTINO Fee $ 7 O�
0 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 rices
> : and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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> K(j(�J�1�� /��CCFfrY Address �U �As«/ (may
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Owner
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J By �' , !• Address
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3 o CONTRA(,70 AGENT
m Phone
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o State License.�X! yy Approved
UI PLUMBING INSPECTOR
FIXTURES NUNf BER MAIN DRAIN
UNITS I FEES UNITSI FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories 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
Com . Sink s Trays To Curb
Dental Units
Drin Ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps ja TOTAL FEES
Urinals Fixture Fee •�Zc,_`
Area Dtains KMainrain Fee
Water Leaders DrainFee5prinklcr Valves Sys. FeeFee rnTOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Slain Drain
Final