NO PERMIT NUMBER �a
LOT NO,
NO, STREET
APPLICATION FOR PLUMBING PERMIT
W a CITCLT[ O
yo No.
3 U Date ,C196 1968 ermit No
I
W LL Fee $
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� Application is hereby made to the City of Cu t' f a permit to install plumbing
0 a pipes and/or fixtures listeq,00-,the Itei�ersdss de'hebEsa�� agrees to install said prices
and/or fixtures in accordance wnh the pro'vis'ion`s of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
a ~ Use of Pr ses
00
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Owner ///iwTc_f�J �'�6000CJ)���— Address ����/J���r/��!/iJ�/,f/f✓��
Address
CONTR CTOR�AGENT
W i Phone ,a �J�`S / �.
W W
u s State License 27,z �� Approved
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U rI PLUMBING INSPECTOR
FIXTURES Nbt13EX MAIN DRAIN
UNITS FEES UNITS 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
Comb, Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Ir ea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Volves Water Sys. Fee �t X10
Permit Fee p'D
TOTAL TOTAL FEE , j, ;�-V
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...