2339 LOT NO.
I ON FOR PLUMBING PERMIT
® CITY OP CUPERTINO
xa AUG 13/1963 Sanitary No.
0 a Date — `"� , '1968 Permit No
CITY OF CIJP :. ,+' Pee $ 14- t 0c)0 Application 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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of-Premises00
I �A
00
3 Owner tl. l"t 1 Add res
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/ \
By1�� AddressICONTRACTOR,AGENT
CL PhoneState License_ I D,-7 a7h Approved �e 9PLUMBING INSPECTOR
HX I URESUM I DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closets Material CS
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
\Vaching Machines Size
\Xrater Softeners Material
'Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM'
Hoppers Size "
Restaurant Sinks Material o P
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
\Slater Leaders Storm Drain Fee
Sprinkler Vatvea Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE O0
RECORD OF INSPECTION
Underground Rough r
.Partial Rough..
.Rough. Complete..
\Qain_Drain
I"inal —