2764 LOT NO.
h0. I FOR PLUMBING PERMIT
N
.W i D OF CUPERTINO
r o - I J 1964 ��'�����'��'jjj{{{ Sanitary No.
0 a Date 196 Permit No 7
CITY F CUPE�TIN� Fee $
0 Application is hereby ma e to t e City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance wit provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws ' able there
w x
r r
Use of remises
00 /
> w 'Zo
0 3 Owne Address
iJ
o By Address
- 0 ` 4 77
— a Phony
w z
ww
a o State License Approved
—U
PLUMBING INSPECTOR
I-IXIURES NUMBER
UNITS FEES UNITS FEES
Water Heats Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
'Wasli Trays STORM DRAINAGE
Washing Machines Size
.Water Softeners / Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
Sanraps TOTAL FEES
Urinals Fixture Fee /
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
5prinklrr Valves
Water-Sys. Fee
Permit Fee
TOTAL 11 TOTAL FEE pp
RECORD OF INSPECTION
Underground Rough...
Partial Rough_
Rough. Complete..
Main Drain
Final._