2730 e.�a" i/
COT NO.
NO. STREET ,
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1 FOR PLUMBING PERMIT
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Z CUPERTINO
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° MAY 7 1964 Y
Sanitar No.
3 a Date 196_
Permit No
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1 plutnbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
Z a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
_Q W and all o ws applicabl thereto.
Cupertino, o.
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Use of Premises
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o a Owner Address
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,AGENT Address
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PLUMBING INSPECTOR
rns- NU RAIN
UNITS I FEES UNITS FEES
Wnter Heate Si7.e CIZ)
Water Closets Material
Bath Tubs G To Cur
Showers To Prop. Line
furies To Existing
Itc en Sillks Not Conn.
Washers Sewer Boxes
rite Disposa s
Waah Trays STORM DRAINAGE
ming Machines Size
�Y�ater Softeners Material
Bar Sinks To Main Drain
om . Sin s rays To Curb
Dental Units
Drin mg Fountains _
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Materia
Sawn - ps OTOTAL FEES
rmals Fixture Fee
Water
,Ir' m
ea ras Main Drain Fee
W
ater Leaders Storm Drain Fee
Sprnnkl'cr Valves Water Sys. Fee
Permit Fee
TOTAL /VoUIFTOTAL FEE L,
RECORD OF INSPECTION
Underground Rough...
.�rtial Rnugh.. - —
Rough. Complete.. _
14ain Drain
Final...