2559 1-0,M, LOT NO, //-3
o s I
® 1 FOR PLUMBING PERMIT
w z JAN 14 1964 Y OF CUPERTINO
r o Sanitary No.
LL JAN 10 1964 SS
0 Date •�- }• 196— Permit No. -
=LL CITY OF Ile O Fee$
o Application is hereby 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 N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Q w Cupertino, and all other laws applicable thereto.
w x
� w Use of Premises
llelo��/AI-Allr�-
00
�
3 Owner /r132E'/J C�[/Cr2/� Address ��/�> e7'—/ir 0
i J C ee)LCJC �F�
z By Address ��T/✓ �lC l U
� CONTRALTO , AGENT
VC,
W z
w w
ao State Licens ' ' 0 c-;, Approved
_U
^ PLUMBING INSPECT
FIX-1 ulths NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate SiZe q R,09
Water Closets y Material G
Bath Tubs To Curb LI/Showers To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Wa>te Disposals
as'h Trays STORM DRAINAGE
Washing Machines / Size
\`Dater Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /so
Restaurant Sinks Material Le
San raps TOTAL FEES
Urinals Fixture Fee /0,00
irea Drains Main Drain Fee :2,00
W ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /,00
Permit 'Fee 7,00
TOTAL /p /a,00 TOTAL FEE /SOO
RECORD. OF INSPECTION
Underground Rough...
Partial Rough.. /— f- . ,
Rough Complete..
Hain Drain
Final... f
t �