2372 (2) d.O to O. I �•C __"` LOTNO. 31
P� NO. Q EET
N _ N FOR PLUMBING PERMIT
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1"'CITY OF CUPERTINO
l AU 21 1963 Sanitary No.
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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.
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LL Use of Premises 4 Alts a W jp _
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aaOwner 41 N 0nv� Address 1
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B pi,�rr�I, -�Qr�n,,4s ���,refl4
y CON'T'RACTOR, AGENT Address_�4 0
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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...