51145 Il✓ COT NO.
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`APPLIC=ATION .FOR PLUMBING PERMIT
i i � D OP CUPERTINO
xo tJAN 25 1966 �. Sanitary iNo.
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30 jU DitCITY 0'� 696 Permit No
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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 prices
> I 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.
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LL Use of Premises
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, 3 Owner Address
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J z Dy Address L
Z -CON7 ACTOR, AGENT
3 Phone 7
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PLUMBING INSPECTOR
/1.�.-u'��
a o State Licen/se �Z / /Ll/—� Approvedw
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FIXTURES A
UNITS FEES _UNITSj FEES
Water Heate d Size
Water Closes Material
Bath Tubs D To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers " Sewer Boxes
Waste Disposals
Waslh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size U
Restaurant Sinks Material
San TrapsTOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee .� p
VV/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee p�
Permit Fee ,q el
TOTAL or TOTAL FEE 9
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final