2687 / c z/ I Q
LOT NO.
NO. EE
L�FO PLUMBING PERMIT
z D CIF CUPERTINO
r o +S,(APR 2 0 9964 Sanitary No.
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pLL /
o a Date � 196— Permit No /V_
3" CITY OF CUPERTINO Pee s
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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
<w Cupertino, and all other laws applicable thereto.
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0 LL Use of Premises .c--
5 3 Own !- Address &4A -
I z By� 9 �• Ad A f Address �i� �i9 ff� //.A/t f
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CONTRACTOR AGENT // C
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a o State Livens ( Approve
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f1 U PLUMBING INSPECTOR
FIX,I uRhs NUIXE
_ UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatunes ! 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 a Trays To Curb
Dental Units _
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ao
re-Drams Main Drain Fee Z O,o
Water Leaders Storm Drain Fee
6pn.klrr Valves Water Sys. Fee E,1 Q
Permit Fee Fj
TOTAL 3 TOTAL FEE �O
RECORD OF INSPE
_Underground Rough... a
Partial Rough-
Rough. Complete- - 2
Main Drain /
Final--- " S