2356 .3,1 I !'\ (�J llnC-YC .S- / 95
/- LOT NO.
NO. STREP.T
AA� PRhI TION FOR PLUMBING PERMIT
z z a v rjl.�c...1 CITY AF CUPERTINO
Y a ' Sanitary No.
ppU' 16 1963 T
3 a atE' 196— Permit No -- -�
w u Fee $ '
LLIRCp7 ^
n w CITVPP9ftioCL &BUT m c0tci the City of Cupertino for a permit to install plumbing
o apipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r i- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable ereto.
Use of Premises '`1 ' " --
00
3 Owner .T. v't I �.i a-h•ts Address
o J
zo -By �f1n Address
CO A CTT,� AGENT
- a Phone .� —fe 3 Z.
w z y
a o�State Licens Approved
y, ,
_U 7 r' PLUMBING INSPECTOR
FIXTURES NUDIBER ji MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Ware, Closets Ma'er:ai
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material _
Bar Sinks To Maih Drain ,
Comb. Sink %Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER"•SYSTEM'
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ,C C!
Area Drains , Q(J Main Drain Fee
Water Leaders Storm Drain Fee
Sp,i kler V VCS Water Sys. Fee
ti '.fJ Permit Fee
TOTAL ,CI[J TOTAL FEE -CU
RECORD OF INSPECTION
Underground Rough... i''•
.Partial Rough.. -
�Rough. Complete.. - _
.lain Drain
Final---