51117 LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
a 1 s CITY 1'6 CUPERTINO
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/PR a 1968 Sanitary No
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0J Date ���� / Y4
I�6 Permit No. 6 7
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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
<w Cupertino, and all other laws applicable thereto.
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a Use of Premises
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> 3 Owner o n OWi �//C / Address �03�� Mwe�h C L
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o By � `re Address
3 F CONTRACTOR,AGENT
— m Phone �S7' S77d ,
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State License Approved
U� PLUMBING INSPECTOR
FIX-1 URES NU, tiLK MAIN DRAIN
UNITS FEES UNITS1 FEES
Water Heate 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
Com . Sink & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Spinklcr Valvcs S Water Sys. Fee
Permit Fee
TOTAL TOTAL FEFA
RECORD OFINSP C O
Underground Rough...
Partial Rough-
Rough. Complete.. 1
Main Drain
Final...