2574 /O I / A.' ' LOT-NO.
TRE
CAI FOR PLUMBING PERMIT
w !SJ JAN 15 1964 ' aF CUPt.RTINO
Y 0Sanitary No.
w ?S0 J Dat A,96_ Permit No
3U s �,r p
w a Fee$ �4
0 Application is hereby 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
a w Cupertino, and all othe laws applicable thereto.
w x
r
Use of Premises
00
3X Owner f—'— Address 77
? z AddWs�//
J ON .. OR, AGENT �T
3 �
— uQi tPhon
ao ' State Licen Approved
U PLUMBING INSPECTOR
H. I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate 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
ConT. Sinks Trays To Curb
Dental Units
Dunking Fountains
Floor Drains WATER SYSTEM
Hoppers ' Size 1 11
Restaurant Sinks Material 166"W:—
Saqd Traps TOTAL FE
Urinals Fixture Fee 3
rea Drains Main Drain Fee Q m
eater Leaders Storm Drain Fee
Sprinkler Volvos Water Sys. Fee ^'u
Permit Fee ^U
TOTAL TOTAL FEE
RECORD OF INSPECTiLQN�
Underground Rough..�.__��_l{
Partial Rough--
Rough. Complete-
Main Drain _5?—
Final--