2338 '720 3 �► ILC 4l W �� LOT NO. 4
PPLI ON FOR-PLUMBING PERMIT
z a D CITY OF CUPERTINO
f AUG 13 1963 sanitary No.
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o < Date — , 196— Permit No 3��
w LL CITY OF CU Pee s 14,o0
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
oa 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 other laws applicable thereto.
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0 LL Use of Premises
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0 3 Owner I a Address
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Z By ��► �� ��— C o/.)ES Address F> 166Z./ t
n CONTRACTOR,AGENT
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— w Phone
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State License I--. Approved
PLUMBING INSPECTOR
FIXTURES D MAIN R I
UNITS FEES UNITS FEES
atcr Heater Size
Water Closets 9L Matera! G1
ath Tubs To Curb
Showers / To Prop. Line
avatories To Existing
Itchen Sinks / Not Conn.
ish Washers ( Sewer Boxes
'paste Disposals /
dash Trays STORM DRAINAGE
Vashing Machines j Size
Nater Softeners Material
Bar Sinks To Main Drain
on-6. Sink w Trays To Curb
ental Units
7rink FoFountains
Floor-Drains WATER SYSTEM
Hoppers Size
estaurant Sinks Material G'
San Traps TOTAL PEES
Urinals Fixture Fee
re.i Drains Main Drain Fee
mater Leaders Storm Drain Fee
'prinklcr Vnives Water Sys. Fee
Permit Fee
OTAL TOTAL FEE [f OO
RECORD OF INSPECTION
Underground Rough... -'p/� t
Partial Rough.. /
Rough. Complete..
'Iain Drain
Final... 7