2743 LOT NO,
NO. Q 5 �
f TI FOR PLUMBING PERMIT
z a ?(MAY
TY OF CUPERTINO
xo 21 1964 sanitary No,
0 4
0 a Date 196_ Permit No v
LL CITY OF CUPERTINO Fee$ 4.00
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
i m and/or fixtures m accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other laws applicable thereto.
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Use of Premises Residential
00
oa Owner Gerald Wytman Address 10575 Orange Tree Lane
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z By Lindsay Soft Water Service Address 351 Meridian Road
- 0
3292-8497 San Jose, Calif.
- 0 Phone
W Z _.
a o State License 212096 Approve l
U - CONTRACTOR, AGENT
FIXTURES NUMBER MAIN DRAIN
' UNITS FEES UNITS FEES
Vater Heater Size
Vater Closets Material
Iath Tubs - -'1 To Curb
-howers To _Prop. Line
.avatories To Existing
Citchen Sinks Not Conn.
)ish Washers Sewer Boxes
waste Disposals
Nash Trays STORM DRAINAGE
Vashing Machines, Size '
�!ater Softeners 1 .00 Material
ar Sinks To Main Drain
mb. a Trays - To'6_u b'
Dental Units '
)rinking Fountains -
'loor Drains WATER_SYSTEM
coppers Size
restaurant Sinks, Material
land—Traps -. TOTAL FEES
Jrinals Fixture.FeeI nn
lrea Drains - -A Main Drain Fee
.Fater Leaders StormDrain Pee
=prinkler Naives Wat" Sys. Fee1 1.00
Permit Fee 1 2.00
COTAL 1 .00 TOTAL FEE 00
RECORD OF INSP 'CTION'
Underground Rough.
Partial Rough.. -
Rough. Complete-! �
\Iain Drain I ,
Final...
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