51075.1 /o�S �7c.• Gd -�
LOT NO.
NO. STI EE.T
- P�PrT FOR PLUMBING PERMIT
" `��{//]�i� ,()i ;;'�� � .I Y UPFRTINO
zo Sanitary No.
0 a Date /� -16 1967 , Permit No.
UZ
w Fee $ S—/, a
I LL
o ApplicaNTY h%y � (� f Cupertino for a permit to install plumbing
o a pipes and/or fixtures listf'P��OT"I inside hereof, and agrees to install sid rice
'zand/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
00
> N
3 Owner Address
o a
Jz By�� 1 Address yVA&* pa
3 CONTRACTOR, A
— u`. Phone ,9d- 7 — O Q�7
wz
ww
a a
a o State License � 3///D Approved
U t4rVPLUMBING INSPECTOR v
CCC"' X
FIXTURES NUNIBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate IT- Size
Water Closets /3 Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories / To Existing
M en Sinks Not Conn.
is Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink m rays To Curb
Dental Units
Drin ing Fountains _ ♦yy S l
Floor Drams COATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rina Fs Fixture Fee SQ
rea rains Main Drain Fee
r/t-�ater—Leaders Storm Drain Fee
sprinkler Valvcster SyS. Fee
Permit Fee 2, cJ
TOTAL 3 7 So TOTAL FEE / To-
RECORD
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final