2275 LOT NO. .,
NO. STF EFT
N ® AP,PLIIICATION FOR PLUMBING PERMIT
a Au CITY OF CUPERTINO
x 0 Sanitary No.
o < .9ate JUL 24 1963 , left_ Permit No.
�a 75
i
w pee $ 42
LL w ( �fjj lip�on�s r bbRTT ' to the City of Cupertino for a permit to install plumbing
0 1 an or xtures fisted'oh-the reverse side hereof, and agrees to install said prices
i N and/or fixtures inaccordance with the provisions of the Plumbing Code of the City of
a Cupertino, and all of r law ap icable thereto `
w t
,. Use of Premis
00 C .
3 Owne Address 911 Q-
0 <
z By Address �7`/,/ . .:
3 - CONTRACTOR GENT'
- 0 Phone�,i �—Z�
W Z I
X
o State License �G S Approved 4,12-e<
9-ht," 4�- 3 Cr
PLUMBING INSPECTOR
i R I R I
UNITS FEES UNITS FEES
Water Hearer pt —0,co Size
Water Closets �,pp Materal
Hath• Tubs To Curb
Showers To Prop. Line
Lavatories x,00 To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
T zsh Trays STORM DRAINAGE
Washing Machines y Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fodntains
Floor DtainsZoo WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 3 700
Area Drains Main Drain Fee pQ
Aater Leaders Storm Drain Fee
nkler V wes Water Sys. Fee 00
p0 Permit Fee p Q
QTAL 37WIl TOT LFEE
RECO OF llNSPECT ON
Underground Rough... 7i
.Partial
.RoRough..
3hComplete..
\•IainDrain