2557 No. Q E.
O OR PLUMBING PERMIT
¢ ® CI OF CUPERTINO
Yo JAN 14 1964 Sanitary No.
o a Date SAN 101964 196_ Permit No
3 LL CITY OF CUPERTi,NO Fees
1 0 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 '
.and/or fixtures in accordance with the provisions of the Plumbing Code of,the City of '
¢ w Cupertino, and all'other laws applicable thereto. -,� . ....
Use of Premises /CSS/j>��/af r•+t '`
00
> 3 Owner Ct'Cir/� Address C-U���T///U
o ¢
zJ �2Ocu«� �c� v
z By Address
o CONTRACT R,AGENT
— m Phone
ao State License -/(5 6 Approved4a r. ,`C����
U PLUMBING INSPE('IS7R
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate I S1Ze 441 Z.00
Water Closets 2 Material GI
Bath Tubs To Curb ✓
Showers To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
WAN Trays STORM DRAINAGE
Washing,Machines Size
Water Softeners Material
Bac;Sinks To Main Drain
Com . Sink a Trays To Curb
Dental .Units -
Dr4nking Fountains
Floor Drains WATER SYSTEM _
Ho pert Size
Restaurant SinksMaterial Gc
San Traps TOTAL FEES
Urinals Fixture Fee /0,00
-Area Drains Main Drain Fee Z.P0
Water—Leaders Storm Drain Fee
',Sprinkler Valves Water Sys. Fee /,00
Permit Fee X4,00
TOTAL 0 /O.ro TOTAL FEE /g',00
RECORD OF INSPE ION
Underground Rough.. —
Partial Rough..
Rough. Complete..
Plain Drain 1
Final....