1919 � �.,:,..G Gid LOT NO,
- NO. " STREET .. _
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APP.LICATL!ON FtOR PLUMBING PERMIT
Z < Eft CITY OF CUPERTINO
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y 0 1 / 17 1953 t Sanitary \'o.
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0 ' Date 196 Permit No. 1
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, 0 t U (1C �I�p�RTINO - Pee $ �.
ApplicaC,ml 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
- > < 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.
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Use of Premises
00 mOwner i( . /
Address
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r .
J ° By e`isaZti -a.:,zer- Address,35 �k ,
one Ph �2y/ _ 337X
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ao State License_C3e_l��a�9 i Approve
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FIXTURLS NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Neater Size
Water Closets Materia'
Bath Tubs To Curb
Showm To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer.Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Al r s Material
Bar Sinks !'I' To Main Drain
onbrSirrk-e.Trays To Curb
Dental Units
risking Fountains I
Floor Drains WATER SYSTEM I�
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water, Leaders Storm Drain Fee
Sprinkler Valves Water Sys: Fee 4
iZ,6'7 Permit'Fee
TOTAL t{ TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough-
Rough. Complete-
Main Drain
Final... ,�-
1