NO PERMIT NUMBER I//3 O I /�L�(_LifiW"`^�ll/ I/.�L� LOT NO.
NO.' F.T
® PLUMBING PERMIT
d CIT CUPERTINO
X o 1FEB 27 1968 Sanitary No.
X _
0 a Date 196 Permit No
w" OF CUPERTINO Fees
I 0 T
° Applica i n Is hereby made to the City of Cupertino for a permit to install plumbing
o` < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
s 1- an fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all of laws applicable thereto.
w i
� r
a Use of Premises
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r3 Owner - - Address U/3 (- (�-�C•��
J RAYNE
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By CONDITIONIpif: Address
° e Rued
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— m Phone. / • p4hlo/rne
UState Licens Approved �� /
PLUMBING INSPECTOR
FIX
UNITS FEES UNITS FEES
Water Neate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 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 Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinklcr valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough_
Rough. Complete..
Main Drain
Final...