51145 (2) p?/� I �rJ(/fZ�V Idi„ LOT NO. �/J
NO. �r STREET'
Per N FOR PLUMBING PERMIT
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WCUPERTINO
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r 0 f APR 4 1966 sanitary No.
0 LL 1;r4s
0 a Date 196— Permit No.
1 LL
cee $
10 Yat0Fist6i1TJ8W ie CiS, of Cupertino for Permit to�install lcumbing
o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r 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.
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� r
.. Use of Premises
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3 Owned Address
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J z Address
O ONTRACT ENT
3 0 Phone
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a o State Licens, o2 o 46Approved
PLUMBING INSPECfOR
HXTURES J E
UNITS FEES UNITSI 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
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee y °
Area Drains Main Drain Fees"
Water Leaders Storm Drain Fee
5pr17klar Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE o u
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final