51139 (2) LOT NO,
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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z i CITY 01: CUPERTINO
x o D Sanitary No.
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` Date 9 Permit No IS
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0 1 JU�1 14 1967 Fee 5 7
Applicatiohere y made to tile n Is e G y o 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 fixt(w a(gq[dadi+l�j�lp �p{q�'isions of the Plumbing Code of the City of
a w Cupertino, ltnd II < r I. I ereto.
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LL Use of Premises
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oaOwner � Address 70fS'/`
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3 t. CONTRACTOR, AGENT
— 0 Phone
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a o State License Z�'� }�� Approv
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PLUMBING INSPECTOR ✓
FIXI URES
UNITS FEES UNITS FEES
Water Heate Size
Water Closes 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 . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers — 3—e Size
Restaurant Sinks Material
San Traps /.s` TOTAL FEES
Urinals •sc Fixture Fee (� 67
Area Drai Main Drain Fee
Water Leaders Storm Drain Fee
Jprinkler Valves Water Sys. Fee S�
a<.. .,/ /Sa Permit Fee o2`rC1
TOTAL rro TOTAL FEE S
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final