51027.7 TO CC /YTf
-P LOT NO.
NO. STREET 1
PLI "Al .N FOR PLUMBING PERMIT
f4 Py OF CUPERTINO
r o ✓ (NOV 3� 1966 >I Sanitary \'u, o `y
Q 4 196 Permit No .J_/ d "�
O . 7
� Uate
a
w LL Y F Fee $
t O
CITY ion is ereby ma e" EoOthe 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
a w Cupertino, and all other laws applicable thereto.
w x
� r
a Use of Premises Q- , K=S-
J
00
o,, 3 Owner,Q�/� �`l /V ei , /,"7 Address h
z By // /'��% / h uiyr/+ii�C+ Iq"C Address �GG 777e Cj I-r./yy0
3 CONTRACTOR, AGENT
Phone 78 9SB�
w z
o o State License X 0 9 y Approved I
U PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size "
Water Closets Material
Bath Tubs To Cur L—
Showers To Prop. Line
Lavatories To Existing
Kitchen Si Not Conn.
ish Washers Sewer Boxes
Waste Disposals
Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin c 1 Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
oppers ize
Restaurant Sinks Material(o �,.*
an raps TOTAL FEES
rinals Fixture Fee ;-7-3-�
tea rains Main Drain Fee .100
�VXrater Leaders Storm Drain Tex
5prinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTALFEE lie
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\lain Drain
Final