2727 h0. STREET IAT NO.-�-•--
D FOR PLUMBING PERMIT
z Z �C tt' OF CUPERTINO
r o MAY 7 9964 U Sanitary No.
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o a Date 196— Permit No
3 C1 �(�
LL OF �uP�(� ^^'' Fee a/. 3 d
' o Application is herebyP'dt}d��RfiOCity 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 a
an fixtures in accordance with the provision of the Plumbing Code of the City of
a w Cupertino, and all other laws a plicable ther
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LL Use of Premises
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o a Owner Address
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o By t CO CTOR,AGENT Address
3
Phony-&'L
— W '+ Z
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ao State LicenseApproved
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PLUMBING INSPECTOR
DRAIN
1'1XES NUMBER — MAIN
UNITS FEES I UNITS FEES
Water Hcate Size t
Water C osets Material _
Bath Tubs To Cur _
Showers To Prop. Line
Lavaturies / To Existing
Kitfhen Sinks Not Conn.
Nis Washers Sewer Boxes
Waste Disposals
aS'h Trays ORM DRAINAGE
as ing Machines f,.ttrocect
Water Softeners al
Bar Sinks ain Drain
Comb. Sin s rays rb
Dental Units
Drinking Fountains
I+ oor Drains WATER SYSTEM
oppers ize
Restaurant Sinks Material
an raps �TAL FEES
nna s Fixture Fee
Area Drains Main Drain Fee
mater Leaders Storm Drain pee
Sprinkler valves Water Sys. Fee
Permit Fee
OTAL u11 TOTAL FEE e 00
RECORD OF INSPECTION
nderground Rnugh. - G
Partial Rough- S�0r
Rough. Complete.. _
34ain Drain —4 r
Final... d -30