2483 Agatul LOT NO.
NO. A'� EF.T �.._„O ., R PLUMBING PERMIT
0 CI OP CUPERTINO
xo �NOV 8 1963 Sanitary No.
O a D ' .3� � 196': Permit No, ��Xj
3U ate ��G?
LL T Y OF CUPER. Fee $ kY 7 1
O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install 'said prices
iw and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Q w Cupertino, and all other laws ap lica le thereto.
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seof Pr mises
N7�r- �
� 3 Ownen a�l"',eD'01- Address 17 y
o B .1.� CO ./i?CGL AULN -6 �!/lt-// Address p
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a Phone Ll k
ao State Licens ��'� -Approved
A-U PLUM V L R
FIX"I URES NUAI BER MAIN DRAIN
UNITS FEES UNITS FEES
`J(/ater ficatec Size
Water Closets Materia;
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks ,Gy Not Conn.
Dish Washers I Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
\ Ming Machines Size
'.Water Softeners Material
fiar Sinks To Main r n
Comb. Sink c Trays To Curb
Dental Units
(
Drinking Fountains I
i'loor Drains _ ;� WATER SYSTEM
Hoppers Size/-
Restaurant
ize -Restaurant Sinks Material VV
San Traps TOTAL FEES
.Urinals Fixture Fee �. Ov
r Area rains Main Drain Fee eTo
+Water Leaders Storm Drain Fee
I Sprinkler Vatves Water Sys. Fee
Permit Fee _ ery
TOTAL
.6PVjj TOTAL FEEii 0 7 errJ
RECORD OF INSP " ON
Underground Rough... —
.Partial
.Rough Complete_
Complete.. _
\lain Drain
Final... i, CV4
v � \V