2662 L 1 / i LOT NO. �
ST F.
D A I TI FOR PLUMBING PERMIT
m a IPMAR 2 7 1964 OF CUPERTINO
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o _ ,/ Sanitary No.
0 a Da�q // �h 196 ` ' Permit No.
W U I Fee $ /f/J/J
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O Application is hereby made to the 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
r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws app��hcable thereto.
0 o Use of Premises _nn ✓1//J(/J/�.�.���� �j
o a Owner �/ i Yom. (/l/� Addres�y eL)' ,1/,///�/./�1��11///���
j z / / C\ s� Address
3 a CONTRACTOR AGENT
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u f State Licens � �1 Approved
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t�_ PLUMBING INSPECTOR
FIXTURES NUMBER MAIN N
UNITS FEES UNITS FEES
Watnr Heater Size
Water Closets �^,r >l Material
Hath Tubs .,2 To Curb
Showers To Prop. Line P
Lavdtories To Existing
Kitchen Sinks �,O�J Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines hlJ/ Size
'sXrater Softeners Material
Bar Sinks 1121,) To Main Drain
Comb. Sink a Trays To Curb
Dental Units '
Drinking Fountains
floor Drains ' WATER SYSTEM
Hoppers Size /Ii
Restaurant Sinks I Materiall&J 51,�/�/,
Sand Traps TOTAL FEES
Urinals Fixture Fee /010)
Arca Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vuives Water Sys. Fee //z V
Permit Fee A7jf
TOTAL TOTAL FEE lelfiw
RECORD OF INSPE I
Underground Rough... -
.Partial Rough..
.Rough. Complete..
'Iain Drain -
Final... Lo •-11