2748 / LOT NO. v
NO. 0 S'�t�
ITI FOR PLUMBING PERMIT
z D OP CUPERTINO
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JUN ;1 1964 Sanitary No.
R4 a
o < Date 196— Permit No
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LLCITY OF CUPERTINO Pee $ d O
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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a Cupertino, and all other,45.vs applicable theret
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nUse of Premises ti
00
3 Owner '�� T Address
?z By C/1 i l . i( /a Nle SG%/� J� Z/4/0'10 771 A/J O CONTRACTOR,AGENT Address7T /J-/ C-C)
3P
- m Phone - 7q 009
u State License /�0 7 � S� ApprovedC
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U It
PLUMBING INSPECTOR
FI]
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
Comb. Sink s Trays To Curb
Dene.tl Units
Drinking Fou.Rains
Floor Drains WATER.SYSTEM
Hoppers Size
`Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
tX/ater Leaders Storm Drain Fee
Sprmklet V.k:7" Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OFINSP�G�(D
Underground Rough.. — - C
Partial Rough..
Rough. Complete-
Main Drain
Final___ p . i