51075 LOT NO.
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fOCICATION 'FOR PLUMBING PERMIT
E / pCplTl'4 01� CllPGRTINO
x p �_� 1 hiUG 22 1968 t' Sanitary No.
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O < Dnte 19652 Permit No
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Application is hereby ma e to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
> r 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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Use of Premises
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0 CONTRACTOR,3 AtGGEINT n m Phone 3 2� 14 `lam, �-•
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a o State License Approved ti
U PLUMBING INSPECTOR
UNITS FEES UNITSI FEES
Water Heate I Size
Water Closets ,7-5-0 Material
Bath-Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
K'iTN§n Sinks ..V :j O 0 Not Conn.
ish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units ('-; U f
Dnn ing Fountains qS SI
Floor Drains WATER SYSTEM
uppers Size
Restaurant Sinks Material
San taps TOTAL FEES
renals Fixture Fee L O J
rea Drains Main Drain Pee
Water Leaders T ,3 O
Jprinklcr Valves Water Sys. Fee
Permit Fee C u
TOTAL TOTAL FEE p
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final