1851 aal�l !�. voss Q n
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
W i :CITY•OF CUPERTINO
' W Sanitary No.
3¢ LL l S
U Dat 196— Permit No i
W
Rtom
xFee $
o
Application is hereby made to the City of Cupertino for a permit to install plumbing
z < pipesrgct/pr�{Fur�� verpse side hereof, and agrees to install said prices
> r and ��i3(tttu�r Grin a e rovisions of the Plumbing Code of the City of
a W Cupertino_and all a laws applic le thereto.
W I
Use of Premises
o_ o
> N
O < Owne Address
ZJ
JZ
By Address
3 �
4 Phon Z1
W
a State Licens Appro d P`
CONTRACTOR, AGOT
Fri-
_ UNITS FEES UNITS FEGS
Vater Heater Size It
ater C osctsMaterial
Fath Tubs _ To Curb r.
bowers To Prop. Line
,avaturies To Existing
.itchen Sinks Not Conn.
is Washers Sewcr—I .
Viste Disposa s
rash Trays STO RAINAGE
F71 ng Machines Size
;Dater Softeners Material
Tar Sinks To Main Drain
_omb�nk�Trays To Curb
enta�Units _
!ria i`�ng Fountrins
Floor Drains WATER SYSTEM I _
coppers' Size
kestaurant Sinks Material
San<�[raps TOTAL FEES
rivals Fixture Fee O
Area Drains Main Drain Fee Q
Water Leaders Storm Drain Fee
Sprinkler Vawes Water Sys. Fee Q
jJ Permit Fee
TOTAL — TOTAL FEE
RECORD OF NSPE TION
Underground Rough .. L
.Partial Rough.. L.
,.Rough. Complete.. — 3
,Main Drain
Final...
. \� ' ^ ■
-
\ pCAI
( n �
� � ■
[/§ 0 CA