2690 -PvIL I b c`� Y\V C LOT NO. `
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E -OR PLUMBING PERMIT
YCUPERTINO
f -.zAPR 17 1964
Sanitary No
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o , Date `r's NO 1964:?4 Permit No o
w CIT R 1 iNir, Fee $ Iy490
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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
<w Cupertino, and all other laws applicable thereto.
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Use of Premises c=s tGw\c.
03 Owner hic
.,�,�(�II�OT T Address
zz ByL hty10 i 'ttFkior, Akbwlt o 11tC.Address �,�• o-X '7ywlk
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- m Phone
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0 d 115 �9 q Approved ==-z o State License
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FIXTURES M E MAIN R I
UNITS FEES UNITS FEES
Water Heater / /,G Size
Water Closets Material
Bath Tubs / To Curb
Sho\vers / Gr,�) To Prop. Line
Lavatories ,D0 To Existing
Kitchen Sinks , pp 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
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size . //
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ,gyp
Arca Drains Main Drain Fee ,gyp
VVI ater Leaders Storm Drain Fee
T-prinklcr Votvcs Water Sys. Fee
Permit Fee pG
TOTAL 1 5e TOTAL FEE /SJ, OD
RECORD OF INSPECTION
Underground Rough...
. artial Rough.. c _
RPough. Complete..
J�Iain Drain — �—
Final... ,