51031 //D t� _ LOT NO.
O. ®�, Ear
LK IQ FOR PLUMBING PERMIT
z a OV r, .#Y OF CUPERTINO
W 2 - s 1966
x p Sanitary No.
LL /
a a Data 196(2 Permit No. �
3 tj LL G� V L O Fee $ S"U
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Application is hereby made to the 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.
g LL Use of Premises
00
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a 3a Owne U Address n J,
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By — Addressl 7 Zj, 4'-
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Phone
f State License,2,B! Approvedt I 1/
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u/ / PLUMBING INSPECTOR
TTI X 10 NU,% BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
is Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners / Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drink-mg Fountains
P our Drains WATER SYSTEM
Hoppers ze
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee / -'q
G
rea rains Main Drain Fee
Vater Leaders Storm Drain Fee
Jprinklcr Vatvcs Water Sys. Fee /Q d
Permit Fee B
TOTAL / TOTALF
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
D1ain Drain
Final...