2612 / Z �� �• LOT NO.
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APPLICA I N FOR PLUMBING PERMIT
"wX< FEB 281964 L-JtT OF CUPERTINO
r o ,/ Sanitary No.
o J Da r�ITV1�rtLr7/�t Ir]rn-r•+�,�I962 Permit No_ ��-
3 U L+iT-Q1TGT1f Lf�1
in Fee$ /7o_G
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 m
and fixtures in accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other laws applicable thereto.
j LL Use of Premises ��«/�✓C�/i/�E
° ° ///� v ao 6 3
oa Owner /'riS�/PY� /iQ(/)/L Address _ x
z By�1���l/�ba/ (� Address d� cdLe/<cSPY_�
' � CONT CEOR,AGENT q �
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02 State License Approved
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PLUMBING�INSPEC170
FIXTURES NU,% BER -MAIN DRAIN
UNITS FEES UNITS FEES
Size
Water Heater � /.CO 'y•OU
Water Closets ?.cc Materia? (1
Bath Tubs % /.00 To Curb
Showers / ' /.tx) To Prop. Line
Lavatories < ,e,0 To Existing
Kitchen Sinks / Not Conn.
Dish Washers / Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines / /.00 Size
_'%Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s,Trays To Curb
Dental Units _
Drinking Fountains
Floor Drains WATER SYSTEM
Toppers Size / 00
Restaurant Sinks MateiiaI'Wt/--
Sand Traps TOTAL FEES
Urinals Fixture Fee /y.00
Area Drains Main Drain Fee y , 00
Water Leaders i Storm Drain Fee
Sprinkler Valves Water Sys. Fee /,e0
Permit Fee .po
TOTAL /y , TOTAL FEE cl o
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
,Rough. Complete..—r-/"1-
Main
omplete..,1=/Main Drain ��-
Fin:d... '�