2609i
LOT NO. -
.T
O.
TT APPLICATI tJi ;FOR PLUMBING PERMIT
FEB 2 8 1964 djkV`)OF CUPERTINO
Sanitary No.
Date i41'-WCUP €�`1196 � Permit No d
Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises / I &c / ,t) (-/f/C°
Owner
By
CONTRA OR, AGENT
m Phone
Z �
W n S1
a i
o State License U
/00 & X (<,
Approved
PLUMBING &0ECTOR
UNITS_
FEES
UNITSI FEES
Water Heater
/y
Size •p0
Water Closets
,j
300
Materia!
Bath Tubs
/ P -Q
To Curb
Showers
/
/ °"
To Prop. Line
Lavatories.r1.'—e
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
/
—
Size
'seater Softeners
Material
liar Sinks
To Main Drain
Comb. Sink c Trays
To Curb
Dental Units
_
Drinking Fountains
floor- Drains
WATER SYSTEM _
Hoppers
Size/ P -.e
.Oo
Restaurant Sinks
D4aterial ^(, n
Sa nd Traps
TOTAL FEES
Urinals
Fixture Fee /)/y0 0
Area Drains
Main Drain Fee k. 00
Water Leaders
Storm Drain Fee
Sprinkler Vaives
Water Sys. Fee
'
Permit Fee. -V-00TOTAL
/�
y• "-'
jj TOTAL FEE / ,
RECORD OF INSPECTION
bide. Dept
Offke G:py
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
0 Sewer Connection Sanitary Permit No. ..........
dumbing Final Plumbing Permit No..=;A�-evp ------------
LotNo. /If—/
Owner or Tenant ...... ... ...
....... ........................
At
Tract -----------------
L�C----------....--------------------...---..._.....-------........---------
DateConnected ------------------------------- ---------------------- -- ----- ------------------ 19.........
Date Final .......................................
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5
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-, _
III 7/63-1M z:�� PLUMBING INSPECTOR