2573 q!
LOT NO.
N p EE
D fE� R PLUMBING PERMIT
N a CI F CUPERTINO
r o JAN 141964 Sanitary No.
SLL %a 30 — � 5
O � Date IN9�� Permit No
3u Nd p
W n Fee $
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
a and/or fixtures in accordance with the provisions of the PlumbingCode of the City of
wCupertino, and all her laws applicable thereto. y
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Use of Premises
20 b
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< CO. CIO AGENT
3
— m Phon ^�' 7 /
oState Licens a 3 U Approved
PLUMBING INSPECTOR
-FIXTURES, NU 13ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water C o� Material
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kltct—den Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposa s
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin &—Trays To Curb
'Denzil Units
Drin�Fountains
I' ood r Drains WATER,SYSTEM
opp� ers — Size
Restaurant Sinks Material
an raps TOTAL FEES
.
rinaFs— Fixture Fee A 00
Ares Main Drain Fee
VWater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /'0 O
Permit Fee .7 -o O
TOTAL TOTAL FEE 700
RECORD OF INSPECTION
Underground Rough:..
Partial Rough..
Rough. Complete..
Main Drain
Final...