2654 .. '/M `J
LOT NO. _
1 . -. .+ STREET `
DPN FOR PLUMBING. PERMIT
CUPERTINO
w 0 Sanitary No.
oa CJateIMAR 17 1964 196— Permit No
3U 00
w Fee $
o A,pp, 19t(F i0�t� RTd'%he 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
a w Cupertino, and all other wapplicable th eto.
aw Gtur� - „ . _
Use of Pre ises
o
3 wrier Address
iJ C
zJtBy Address
a \ CONTRACTOR,AGjENT
— m r(Phon
w 2
a2 ALate License,;%7 rte/ J6 �f Approved
—0 PLUMBING INSPECTOR
FIXTURES NUi\
UNITS FEES _ UNITS FEES
Water Heate Size -f
Water Closets Material _
Bath Tubs '•:'t To Curb
Sh" .eers To Prop. Line
X-
Lacries To Existing
Kit en Sinks Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE -
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drai Main .Drain Fee
Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAE F 11 TOTAL FEE
RECORO OF INS TION
Underground Rough.. O
Partial Rough..
.Rough. Complete..
MliipDrain
Final...