1763 (2) LOT NO, 1.
NO. STREET
� 1
FCICA-TPP POR• PLUMBING PERMIT
CIT Y OF CUPERTINO
AUG 10 1962 : L .
Date , 195_ Permit No. ?6s
v CITY Orr CUPERTINO Fee$
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing.Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner �6 Address,:::
By ( �� _ Address s3' tet/
CONTRACTOR, AGENT
Phone, 46",7p Approved i
y PLUMBING INSPECTOR)
--T—[X—TURES NUMBER_T17— MAIN DRAIN
UNITS FEES II JUNITSI FEES
Water Heater t jI Size
Water Closets Material
Bath Tubs To Curb-
Showers �, To Prop. Line
Lavatories To Existing
Kitchen Sinks .I II Not Conn. �' ::I.
Dish, Washers II SEWER BOXES
Waste Disposals II
Wash .Trays STORM DRAINAGE
Washing Machines �, �I Size
Water Softeners Material I
Bar Sinks . - To Main Drain
Comb. Sink a'Trays ' To Curb _�
Dental Units �
Drinking Fountains! II _
Floor Drains WATER SYSTEM
HoppersI j I Size
Restaurant Sinks •Material
Sand-Traps TOTAL FEES
Urinals _ Fixture, Fee
Area Drains; Main Drain Fee I
Water Leaders Storm Drain Fee
Spinklcr Vaty I Water Sys. Fee
Q U JM m2ek iC Permit Fee
TOTAL . I TOTAL FEE
RECORD OF INSPECTION
Partial Rough '
Rough Complete
Final