2070 �O 7.:�P ejjgifD/ �YJ ( Y/! ' LOT NO. T-
NO. STP&ET .
APPLICATION�FOR PLUMBING PERMIT
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FMAY
OF CUi?GRTINO
1 ° 171963 , Sanitary No. s
° < Date—r T�/ (�C ��['[� 196— Permit No oZU / U
a }i 1 b 5�1S r� ► d 1�b� 11�' Pee $ Go
° Ap liea i n i ereby a e the Gty 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 prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other ws ap licable thereto.
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aUse of Pr mises
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PLUMBING INSPECTOR
FIXTURES NUIN BER MAIN DRAIN
UNITS FE17S UNITS FEES
Water Heater /. 00 Size
Water Closets 3 0 Material
Bath Tubs / /,p Q To Curb
Showers ,0O To Prop. Line
Lavatories ,�j 3.00 To Existing
Kitchen Sinks -/ Not Conn.
Dish Washers / A001 Sewer Boxes
Waste Disposals /-
Wash Trays STORM DRAINAGE
Washing Machines —Wn Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. ,Sink i Trays To Curb
Dental Units _
Drinking Fotintains
Floor Drains WATER SYSTEM
Hoppers Size
ta
Resurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 00
Area Drains Main Drain Fee Z
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\hater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /'00
Permit Fee 2 .odt
TOTAL /Z tv TOTAL FEE p
RECORD OF INSPECTION
Underground Rough...
.Partial Rough_
.Rough. Complete.. \
\Maur Drain /1 (Y I ,
Final...