51001.4 (2) r�oZ I C U I & ,� l LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO'
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Y p Sanitary N0.
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3 a Date December 10— 1968 Permit N
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Fee $ ? 59
LL 0 Application is hereby' made to the City of Cupertino,forra permit to install plumbing
0 a pipes and/or fixtures listed on the reverse side hercof,land 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.
LL Use of Premises
00
3 OwnerT• J. 9=11 Address 22164 Via Camino
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J BR—We Water Contitioning Inc- Address243—B Moffett Blvd.
3 CONTRACTOR, AGENT Mountain View, Calif.
— W Phone 967-4546
Y StateLicenseF'��`�(pJG�o� Approved
PLUMBING INSPECTOR
FIXTURES
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.
Dish Washers Sewer Boxes
Waste Disposa s
W as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sinka Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sawn T Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
V—ater Lea ers Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final... — 7
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