51104 zb-s4i Cl Av LOT NO.
NO. s"EFI'
fMLIT �fy� FOR PLUMBING PERMIT
z a D Gs�--i ( OL' CUPERTINO
W ¢ 111 ,�VVlll 11�
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Sanitary i\u.
LL 'AUG 4 1965 I l o
o J Date 196_ Permit No
3a
U tee S StT
= 0 AG{1TY ,0€hC4FuERT1
I do � e n Gty of Cupertino For a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in ac dance with the provisio s of the Plumbing Code of the City f
a w Cupertino, and at oth r applicable ther o.
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� r
a Use of Premises
JLL
O 0
> 3 Ownerx 1;e,& G!/..u./- —,AAddres
0 J
By Address G
0 CONTRACTOR, AGENT
3N Phone x '
w z
p 07. State License y w l Approved
a o
U/ I PLUMBING INSPECTOR
J
]FIX I URFSNUMBER
UNITS FEES UNITSI FEES
Water Heate Size
Water Close's Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays I STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Coin . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES�
Urinals Fixture Fee !�
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprf kler Valves Water Sys. Fee
Permit Fee
T AL TOTALFEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.N'Iain Drain
Final