2663 LOT NO.
I OR PLUMBING PERMIT
z z ,Its R 27 1964 ` or CUPERTINO
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o Sanitary No.
o a Date
(1 �� 196't Permit No 6 6 3
w U C1 RTINO Fee $��/��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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws,aapplicable thereto.
Use of P/remises 4�-dl )/'/./W -
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CONTRACTOR, A NT
— uai Phon ��� :/ND
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aState Licensee I .Approved
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PLUMBING INSPECTOR
HX I URIlb NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
`.Vater Heater 1,,M Size
Water Closets �� r /J Material l%,4
Bath Tubs D To Curb
Showers / �.� To Prop. LineN'
Lavatories ��i To Existing
Kitchen Sinks �, Not Conn.
Dish Washers r Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines /i0 Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units .
Drinking Fountains
I'loo: Drains WATER SYSTEM
Hoppers Size q
Restaurant*Sinks Material
San raps TOTAL FEES
rinals Fixture Fee
Area rains Main Drain Pee V
Vater Leaders Storm Drain Fee
Sprinkler Naives Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough... c
.,Partial Rough—
AZgh Complete..
Main Drain _ t
Final...
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