2621 COT NO.
NO. STREET
D OR PL
UMBING PERMIT
z d I F CUPE:RTINO
xo � 'MA 4 1964 `, Sanitary No.—
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o Date 7 — 19G Permit No a- v
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W LL 1T.Y .0F Off RTiNn Pees
O App icafion is hereby made to the City of Cupertino for a permit t install plumbin '
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r 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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Use of Premises
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3 r CONTRACTOR, AGENT
— 0 Phone
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State Licenses Approved
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PLUMBING INSPECTOR
FIXTURES M E MAIN R I
UNITS FEES UNITS FEES
Water Heater Site
Water Closets r�2 Materia;
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes 6c)
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar-Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units
Drinking Fountains
t-lbor Drains WATER SYSTEM
Hoppers, Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee " a--t/
Area Drains Main Drain Fee r�°-v
\Vater Leaders Storm Drain Fee
'Sprinkler Naives Water Sys. Fee
Permit Fee
TOTAL e TOTAL FEE iy w
RECOR OF INSPECTI
Underground Rough._ -15-
.Partial
.Rough. Complete_ 3 —
Main Drain �J
Final... 1