2747 Fla r of . �:t�� LOT NO. �3 46 _
NO.
AM
ftJ IC�aTI FOR PLUMBING PERMIT
OF CUPERTINO
Ro UN 11 1964 Sanitary No. (�
0 a Date 196_ Permit No /
CITY OF CUPERTINQ Fee $ 2/'
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o < 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
wCupertino, and all other laws applicable thereto,
j W Use of Premises
00
oa Owner DUC Ir Address z_j 4/
Jo- IBy(��/�' . "PPb5 �I�G_ Address/�/�. o%'7a/J/
CONTRACTOR, AGENT "AIV
3 m Phone SZI O�
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aa'rState License A/ 7 �S Approved
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—0 PLUMBING INSPECTOR
�7
FIXI URhN NU,
UNITS FEES UNITS FEES
Water Heate 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
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink &'Trays o Curb
Dental Units'
Drinking Fountains
FI6or Drains' WATER SYSTEM,
Hoppers Size
Res[aurant Sinks Material
Sand Traps TOTAL FEES
Urinals 1 Fixture Fee
Area Drains Main Drain Fee
Nvater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OFINSPECTI
Underground Rough...
Partial Rough..
Rough. Complete..
'Iain Drain
Final._