2603 La P,alQma Drive �ys�
�K' LOT NO.
IVP�APPLICATION FOR PLUMBING PERMIT
FEB 2 8 1964 CITY OF CUPERTINO
Date — 1- 4 _ ,..,,.,195_ Permit No. c ),
I PE E :. ' -
Fee$ /S0 0
Application is hereby,made to the City„of Cupertino for a permit to install plumbing
pipes and/or fiictures,listed.on the reveise'side hereof, and agrees to install said prices
and/or fires in accordance,with &0 provisions of the Plumbing Code of the City of
Cupert� , and all other laws applicable thereto.
Use of Premises Residence
'a”
" Owner Ward Crump Address Box 634 Cupertino
B Crowley
Address855 ckson Mtn View
CONTRACTOR, AGENT _
Phone Approved 4,
PLUMBING INSPECTOIY�
FI}RTURES NUMBER MAIN DRAIN
I UNITS-1 FEES 11 UNITS I FEES
Water Heater / 1 11 Size q..,' I 2,00
Water Closets I Z Material Gt
Bath Tubs �, To Curb f/
Showers /, �� To Prop. Line
Lavatories To �ng 'To
Kitchen Sinks / f� N t oon -r
.Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines I Size
Water Softeners Material j
Bar S{nks To Main Drain
Comb. Sink &Trays To Curb
Dental Units ��
Drinking Fountains it
Floor Drains Jj WATER SYSTEM
Hoppers Size /'t 11_
Restaurant Sinks Material fad 1/,00
Sand Traps �� TOTAL FEES
Urinals Fixture Fee /000
i Area Drains Main Drain Fee'
Water Leaders Storm Drain Fee
Sprinkler Valves I I II Water Sys. Fee �
Permit Fee 1 2,O o
TOTAL /0 1jU- 11 TOTAL FEE /,!;,70o
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final '�, _ t�,s I AAA
Bldg. Dept
"- Office Copy
BUILDING INSPECTOR'S OFFICE b
CITY OF CUPERTINO 0 O
❑ Sewer Connection Sanitary Permit No ..
' - Pltunbing Final Plumbing Permit No.;'r.:.'tiI°c�.�1..°.........
:
1
` Lot No ... t r ............
1 �1
Owner or Tenant .....
�..
! �
Tract ---- ......----------------.`
Date Connected ...... - -- - .........- - `°s -� I9..... -
Date Final , , ,;r i ---' 9 -
- ...�:
:
-]11 7/63-IM
PLUMBING INSPE OR
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