2479 /(.�-/ EE.o C.lifs'c�.�i✓f 'LOT NO.
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P1. 1 OR PLUMBING PERMIT
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Eo f 963 Sanitaryl No.LL7!�
O a Date �� 196 3 Permit No
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CITY OF CUPERTINO Fee $ iron
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� Application is hereb}' made to the City 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 accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
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�. Use of Premises ✓/�6tE �s aE.✓�+�,
5 3 Owner Address (�d/E.Ar�.✓v_ l/.�fif
zz By ✓L� /s�i9�%r /�B� Addresse^�� fE�/Ety✓/rfi�
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3 9�� 900
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u S State License �Ie5e Approved
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FIXTURES NUM E IDRAIN
UNITS FEES UNITS FEES
Water Heater / 1,410 Size
Water Closets oo Material
Bath Tubs / /00 To Curb
Showers Z 1,pp To Prop. Line 2 po
Lavatories }/ /f_ pp To Existing
Kitchen Sinks / /po1 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines j /00 Size
'Niter Softeners Material
Bar Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ,�GO
Area Drains Main Drain Fee .2. 00
Water Leaders Storm Drain Fee
7-prinkler Vanes Water Sys. Fee / OC
Permit Fee 00
TOTAL ,j po TOTAL FEE %A. 00
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Undergrou Rough...
.Partial Rough..
Rough. Complete..
Main Drain
Final... T{