5113 I Q I t I r\ Q ��+� LOT NO.
NO. 5
T
D FOR PLUMBING PERMIT
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z d OF CUPERTINO
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ro (JUL 29 1965 Sanitary \'0.
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0 a Date 196— Permit No
3CITY OF CUPERTINO
w LL Fee S
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� pplicatihereby m
Aon is ade to the City 0f Cupertino for a permit to install plumbing
o 1 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in
rice with the provisions of tubing Code of the City of
a w Cupertino, and all her aws applicable thereto.
Use of Premises
M � e
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i- 3 Owner ( `� C Address S it
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z By -A � � Yl S' 7 �U Address S! T/f �^
O ONTRACTOR, AGENT
3 < Phone u cfta 7
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0a X /.s 33 ��
0 r State License, ApprOv
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—U (,�- PLUMBING INSPEC R
FIXTURES N
UNITS FEES UNITS FEES
water Hcatc 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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water'Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains - WATER SYSTEM
Hoppers Size
:Restaurant Sinks Material
Nand Fraps TOTAL FEES
Urinals Fixture Fee
~—
Area Drains Main Drain Fee
W ter Leaders Storm Drain Fee
sk,rijkle, Vnlvcs Water Sys. Fee
ACuMM Permit Fee Z
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final