2734 �.' ��I�G� �h P,a/�•T'Z.[A` LOT NO. I S
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p .r AjPj PLICATIaT� FOR PLUMBING PERMIT
z Q IhTY OF CUPERTINO
Ear.8Y 7. 1964
r o Sanitary No.
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0 U Date 196_ Permit No
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W CITY, OF CUt', 1190 FeeWinmstafIll0Application is herebymadetothe City of Cupertino for a permmbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures m accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all of laws applicab a thereto.
Use of Premises
00
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o a Owner Address
zJ
z B Address
p coNTRACLO ,AG NT
3 �
— m Phon
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02 State Licens Approved ,
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PLUMBING INSPECTOR
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UNITS FEES UNITS FEES
`Water Heare Size To V
er C osets Materi ✓�
Ba 'Tubs To Cur
S—fivers - To Prop. Line
La atories To Existing
Kitc en Si s Not Conn.
Dis 1. Washers Sewer Boxes
Waste Disposa s
ash Trays STORM DRAINAGE
Was g-Machines Size
ater Softeners Mater at
at Sinks To Main Drain
om . Sink s rays To Curb
Dental Units _
Drinking Fountains
F our Drains WATER SYSTEM _
Hoppers ize 0 d
Restaurant Sinks Materia
San raps OTAL PEES
rinals Fixture Fee . Q
ren rains Main Drain Fee .0 0
ZT/ater Leaders Storm Drain Fee
--v- Water Sys. Fee 106
Permit Fee
TOTAL d0 TOTAL FEE 79, co
RECORD OF INSPECTION
Underground Rough.,
Partial Rough..
Rbugh. Complete..
14ain Drain
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