1903 (2) • 1 • � LOT NO. y
NO. S EET
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11YYA2PL''ICA9TaGN gOFFOR PLUMBING PERMIT
CI /oCUPERT�INO
WJAN 7 1963 ` c y
Date T— 3 19Y 3 Permit No. `
CITY C: "DERTINT) Fees as =
Application is hereby made to the City of Cupertino for a permit to install plumbing
0 . 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
Srs Cupertino, and all other laws applicable thereto.
Use of Premises[
:a V
y Owner��`� / +y �> Address
By1-11.. r � JcT.I.✓I & tlddr 1 _
CONTRACTOR, AGEM
Phone^ =cd's`:l Approve
- � PLum aG W PELT R
PIXTURES NUMBER _MAIN R I
UNITS FEES UNITSFEES
Water Heater Size
Water Closets aterial
Bath Tubsj I I To Curb
Showers To Prop. Line
Lavatories To Exist'n
Kitchen Sinks W �� ! 1
Dish ashersgR BOXES� of
Waste Disposals
Wash Trays ��_ STORM DRAINAGE
Washing Machines / �I Size
Water Softeners Material j
Bar Sinksl To Main Drain
Comb. Sink &Traysj To Curb
Dental Units
Drinking Pountains� _ �I
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps 11 TOTALk FEES
Urinals Fixture Fee r rs
Area Drains �Main Drain F,eeAl
Water Leaders Storm Drain Fee I ,
Sprinkler Valves II Water Sys. Fee al� . -tA
Permit Fee — �; ,rbd
TOTAL TOTAL FEB. =.pi.
RECORD OF I&4&WON
Partial Rough t _ _
Rough Complet — r "' •i�
Final a?— t
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