NO PERMIT NUMBER (2) 11261 4 'q f 4/4YC7 LOT NO, z2 f3
NO STREFT
/5 E'AP1bCATI.OFOR PLUMBING PERMIT
.z i IjY OF CUPERTINO
r0 'SEP 20 1966Sani[ar} \o.
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a Ung - �s�% 9 1,964± Permit No
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w LL �� Ci�i�f�Cn � ! Fee $
n0 Application is li r29Sy4r i ltry�llthe Cit))of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on fhe reverse side hereof, and agrees to install said prices
> I 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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LL Use of Premises U✓ ,t/1
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3 Owne4�U62-4— CJ' I V/S Address//26/ 41PAAY4 CT
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CONTRACTOR. AGENT
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c o State License 3 0 !y3- Approved_
U „/ PLUMBING INSPECTOR v
FIXTURES NUMBER MAIN L) AIN
UNITS FEES UNITS FEES
Water Hcatc Size
Water Closets Material
Bath Tubs To Curb
She,wrr{/ ? , p / 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
Comb. Sink s Trays To Curb
Dental Units
Nnkg Fountains
rains WATER SYSTEM
rs Fr,TCT.ttSize
ant Sinks Material
ra"ps TOTAL FEES
yi:ri / Fixture Feerains Main Drain Fee
Leaders Storm Drain Fee
•r Valves Water Sys. FeePermit FeeL TOTAL FEE t 0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final