51038 QV ('Pr- LOT NO.
NO. 0 T
JQ�
FOR PLUMBING PERMIT
d VJUL
Y OF CUPPRTINOo 19 1965 Sanitary No.
� 4
o a Date 1965 Permit No
W CUPERTINO Fee $ 7
2 LL
O Application is hereby made 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 prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
00 Use of Premises
> 0 �/
3 Owner �• C�• �J'S�cy/�2/ Address ���?-SR6 q
i y P 'K/ 21 (n /off- E. '�/V z S7.
2 Z H •S /YI/r�.2- Nh7 0 - Address
0
CONTRACTOR,AGENT .y Uq N
3 0 Phone .Z..�6
W Z
w w
a o ate License ed 400- 3���_4�
PLUMBING INSPECTOR
FIXTURES M ER MAIN DRAIN
UNITS FEES UNITS1 FEES
Water Hcatcr Size
Water Closets ,G o Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 'p p 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
Comb. Sink w Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee of
Area Drains Main Drain Fee U
\Water Leaders Storm Drain Fee
Sprinkler Water.Sys. Fee /. QQ
Permit Fee o2,00
TOTAL .� e2,00 TOTAL FEE .00
RECORD OF INSPECTION
Underground Rough...
.Partial Rnugh..
.Rough. Complete..
Main Drain
Final...