2355 NO.NO. C7. LOT NO.
e.�
5 FOR PLUMBING PERMIT
N
Z _ O TY OF CUPERTINO
r 0 I AUG 16 1963 t Sanitary No.
3 0J Date 196_ Permit No ad3� 5
U
= o CITY OF CUPERTIM0 Pee$ a7z- C L
LLw pphcatign is hereby made to the City of Cupertino for a permit to-install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< W Cupertino, and er laws app ' le thereto.
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Use of Premi s
00
aa Ow Address
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o B Addres
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aState Licens Approved
- 0 et.`7dR iSS6EA'OR
7IXTURES NUMBER 11 MAIN DRAIN
UNITS rely UNITS FBIS
2,Cb
ter Z IG Size .0
scts .d 0 Material
p 0 To Curb
To Prop. Line
OQ To Existi
inks .pp Not onheis Sewer B xes 9
sposals _
'Uaslr i Trays STORM DRAINAGE
ash MgMachines Size
JUater�ftencrs Material
Iia Sinks To Main Drain
Comg—s"nIc s< Trays To Curb
.Dental Units _
rinking Fountains
'P oor Drains –WATER
Hod ppers Restaurant Sinks ria
I-Sand Traps OTAL FIT
renals Fixture Fee / . .OU
ren pains Main Drain Fee X.00
'Water Leaders Storm Drain Fee
Sprinkler Varves Water Sys. Fee 1,06
Permit Fee _pQ
TOTAL Lt�I TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
''.Partial Rough..
.Rough. Complete..
\4ain Drain –
Final... D r-