2773 / LOT-NO.--c
I FOR PLUMBING PERMIT
a Y OF CUPERTINO
w z ? JUL 31 1964
x 0 Sanitary No.
3 Date 196 Permit No 2'73
CITY OF ERTINO'
U Fee $_ Zl,,
W LL
I O
� 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 allother awwss applicable thereto.
W Use of Premises
0 0
3 Owner ��« Addres;� .G7yC
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Z By�/� S� �C �— Address �vaN��; FT
3 0 CONTR�NT
— 0 Phone �L�P� 3c) l 7 d
W z
ao State License�(� ���� Approve
U PLUMBING INSPECTOR
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water'Heate Size 4r"
Water Closets Material " 4
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kittken 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
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material Z�pp f
San raps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee e ot'J
Water Leaders Storm Drain Fee
Sprinkler Valves WaterSys. Fee p0
Permit Fee
OTAL' / TOTAL FEE r Q
1, RECORD OF INSPECTION
Underground Rough...
Partial Rough —
Rough. Complete.. — —G
Main Drain
Final...