2558 (2) /�07�- I � ✓ .U. LOT NO.
NO. Q TRE
�1 D N. FOR PLUMBING PERMIT
i d C OF CUPI:RTINO
E p
VIJAN 14 1964 smear No. _
ro y
o a Date JAN i u lyb4 196_ Permit No TSF
3� CITY OF CUPERTi1O
wLL Fee $ /7,00
' o
� Application is hereby made to the City 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 in and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
w Cupertino, and all other laws applicable thereto.
wx
LL Use of Premises eEsio�✓�f
00
3 Owner 41. w'o C'e&,a f� Address U17er2
Oa
J
By �QoGe ��y �C Address /V71V !//F.(tJ
O CONTRA OA, AGENT
— Z Phone
w z
w w
a o State License Approved
—UT -
PLUMBING INSPECTOR
FIXTURES NUTN BER jj MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heate I Size
Water Closets 3 Material Gr
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 9, To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units _
Drinking Fouhtains
I1obr Drains WATER SYSTEM
Hoppers . Size .r 000Restaurant Sinks Material G.
San raps TOTAL FEES
rivals Fixture Fee 2,00
X,,,, Main Drain Fee 2,00
�ater Leaders Storm Drain Fee
Sprinkler Vatves Water Sys. Fee /,00
Permit Fee 2 1 0 0
TOTAL Z /z.,o TOTAL FEE 17"10
RECORD OFINSP
Underground Rough..
Partial Rough_ y
Rough Cplete.
Main Drainom
Final...