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2372 (2) d.O to O. I �•C __"` LOTNO. 31 P� NO. Q EET N _ N FOR PLUMBING PERMIT Z `— 1"'CITY OF CUPERTINO l AU 21 1963 Sanitary No. y O 1.0 3Q Date fy 1963 Permit No �— LL UjY OF QP_RTfl1+" Fee $ e u nW pplicat�on is here y made to the City of Cupertino for a permit to install plumbing 0 a _pipes.=fixtures listed on the reverse side hereof, and agrees to install said prices i m 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. wx r r LL Use of Premises 4 Alts a W jp _ 00 aaOwner 41 N 0nv� Address 1 C ZJ B pi,�rr�I, -�Qr�n,,4s ���,refl4 y CON'T'RACTOR, AGENT Address_�4 0 - 0 Phone �f7g �lll o o State License o _Approved PLUMBING UNITS PCES 11 UNITS FEES Water Renter f Size " Water Closets Material i Bath Tubs To Curb Showers To Prop. Line Lavatories 0 To Existing Kite ren Sinks Not Conn. Dish Washers I Sewer Boxes Waste Disposals Wash Trays STORM DRAINAGE Washing Machines Size _ Water Softeners Material Bar Sinks To in Drain Comb. Sink s ays To Curb Dental Units Drinking Fountains I+lour Drains WATER SYSTEM Hoppers Size Restaurant Sinks Material an raps TOTAL FRES rinalllss -- Fixture Fee �Y7 rea Drains Main Drain Fee „ems Water Leaders Storm Drain Fee Sprioklerynives Water Sys. Fee .4 vim Permit Fee TOTAL TOTAL FEE J , RECORD OF INSPECTION Underground Rough... .Partial Rough- .Rough. Complete.. Nfain Drain — O— rx Final...