2462 /0f�3y farrc�isc_ ;aG
LOT NO.
NO. STaEP.T .
,XPRLICIA71 N,, FOR PLUMBING PERMIT
" d ® �TC••�� ZY OF CUPERTINO
a 0 SanitaryNo,
Y ° !OCT 2 9 1963 u
R - Z
° a Date 196— Permit No 1
Fee3 U $ Ct Ct
LLT [C [Cpp��
10 ANRliTtVo,aerrbylPF4lt itkh'nCity 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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w .Cupertino, and all other laws applicable thereto.
w x -
,� Use of Premises00
_
� 3 OwnerS`��^,tHJG;g 7?A,/ Address/Uvl?yz-
J y 1 ,�"�fiF �
z z B 4-L z `e / Address
° NTRACTOR, AGENT
w "z Phone.
I
u f State License �u Z f Approved"�
a(off , - - - - _
j/„ '"� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
`Nater Heater Size
Water Closets Mater.al
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
'Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
*,VSter Softeners Material
Bar Sinks To Main Drain
Comb. Sink w Trays .To Curb
Dental Units
Drinking Fountains
Flior Drains WATER SYSTEMI
Hoppers Size
Restaurant Sinks Material
San T�raps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
\Erater Leaders Storm Drain Fee
Sprinkler Ypives Water Sys. Fee
•G+ZI Permit Fee V-ZZ
TO a-u TOT t FEE
RECORD OF DNSPECtION
Underground Rough / Z7
.Partial Rough..
.Rough. Complete..
Main Drain
Final....