1645 LOT NO. a
NO.
® APP LICAT� I�� R PLUMBING PERMIT
/JUL 18 1962' CUPERTINO
I Date I�Q�Z-- Permit No.
s'
Iv Fee$
(b
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
a
Owner Address
n
By Address9/� 7�/aaH G vC
coN crox, AGENT
Phone - /3f0 Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hearer II Size
Water Closets Material
Bath'Tubs To Curb
Showers �� To Prop. Line
Lavatoties To Existing
Kitchen Sinks I I II Not Coon. I I
Dish Washers SEWER BOXES
Waste-Disposals
Wash ,Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Traysl 1 II To Curb
Dental Units
Drinkjng Fountains) II
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
jC,caEFr-amsj Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I/-,$' I II Water Sys. Fee
_ I 1 11 Permit Fee /, a-6
TOTAL I/-} I/.aa II .TOTAL FEE 9.0 (3
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final �7_CS