2377 Qa(o rl7 I . COT No. 3 i
P� No AQ,C ON FOR PLUMBING PERMIT
pSn
CITY OF CUPERTINO
x ° ' AUG 1 1963 Sanitary No.
0 Date 11 196-A? Permit No
3a
$ GC
' o GsTY OF G�aPEbRT ^'^ Fee '
Apphcahon ,s here y 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
i m` 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 _ �1Q-
00 (� �
�
3 Owner �lM.uL)n & Address can2jX&
z J (�
� z By LRIAC144 nmLt - -�� Address C�SQQ
C CfOR,AGENT
3: f
— 0 Phone 314• g 1 1
W
ao State License .3 _ 1.243V!9 1 I _Approved -•��'u�VLG
PLUMBING INSPECTOR
—rrsrrn�r NUNMAIN DRAIN
UNITS FEES UNITS FEES
Water HenterEll
Size L
'ater C osetsMaterial ),
Hath Tubs To Curb _
Showers To Prop. Line
LavatoriesTo Existing
Kitchen n Sinks Not Conn.
Dish—WashersSewer Boxes
Waste'Disposals
1Vash TraysSTORM DRAINAGE
Washing MachinesSize
Water Softeners Material
Isar Sinks To Main Drain
Comb. Sink m Trays To Curb
Dental Units
r—_
Drinking Fountains
r oor Drains WATER SYSTEM _
Hoppers . Size 11, 1tl�
Restaurant Sinks Material AA1v
San raps TOTAL FEES
Urinals Fixture Fee 60
rem Main Drain Fee ,�,00
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee ,g0
Permit Fee 100
TOTAL. TOTAL pEE 00
RECORD OF INSPECTION
Underground Hough... •—�O �-7
.Partial Rough.. _ 2
�Rough. Complete.. — � ,
.jun Drain
Final... I ''