51027.7 V l- � A& 2d.LOT NO.
�(l. Q 5 E
D FOR PLUMBING PERMIT
w z lS,1 JUN 25 1965 Y
OF CUPF.RTINO,/:•r?� 79- 79
u.3 r o Sn• No.-
0
` Uate ✓uf9 P_ 2 196 S No,Z/ 027.
w LL CI Fee 5
� 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
I and/or fixtures in ac :nwith the provi s If the Plumbing Code of the City of
w
w Cupertino, and all of laws applicable th-reto.
� r
a LL Use of Premis
00
� • . �ZlStA
> UI
0 3 Owner �1 � Ay4ddress
oa
Z J
z By�� P•yCiac. e �C'- Address
O CONTRACTOR, AGENT
3
— `Z Phone ,IJZ
w z
W w
a
a o State Llce se Approve
—U
�� PLUMBING INS CT
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Warer 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 RAINAGE
Washing Machines Q
Water Softeners Material Com
Bar Sinks To Main Drain ...n
Com . Sink u Trays To Curb
Dental Units
Drinking Fountains
Floor Drains
AT SYSTEM
Hoppers
Restaurant rrial
fahkSan Trap T FEES
Urinals r
Area Drains rain Pee
eater Leaders Drain Fee Q LWSprinkler Valves r Sys. Fee
it Fee'TOTAL AL FEE �D
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
14ain Drain
Final