51104 Plumbing Application / 0 5 .3 V I LOT NO.
APPL ION FOR PLUMBING PERMIT
(AUG 18 1966 U CITY O'F/CUPERTINO
IT)Pat fDyUUP 19"
Permit No.
� E��� ��YI/ Fee $ �o-o
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
wy
Owner 1) r A L p S Addressl0—'3 6
By G U L 1 1 A ►V - Address 3 O £ RL Y J1Veee•A v�
CO croa, AGENT
Phone Ooco Approve'
PLUMBINGINSPECT
---71=URES NUMBERMAIN R I
I UNITS I FEES II IINITSI FEES
Water Heater I - I Size
ate, C osets I Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories I To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb I
Dental Units I II
Drinking Fountainsl I f1 _
Floor Drains I I II WATER SYSTEM
Hoppers II Size
Restaurant Sinks II Material
Sand-Trapsl 1 II TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders I Storm Drain Fee
Sprinkler Vaives I Water Sys. Fee
Permit Fee
TOTAL J TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Compute
Final