2694 hH,o U�/yC LOT NO. S
NO. ET
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{ 10� R PLUMBING PERMIT
d CITf
CUPERTINO
r o rl APR 17 9964 Sanitary No.
LL /� /
0 a Date 1 /'/ � 19(>� Permit No IVn
3" TiN., /s6�0
= LL ITY OF CUPER I �, I Fee $
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 and/or fixtures in accordance with the provisions of the Plumbing Code Of the City of
a w Cupertino, and all other laws applicable thereto.
w x
LL Use of Premises
00
aa Owner �Uc a{FLG DT Address/VOe/V, L!//�/Cz/ESTE�S-T
,tail/, AddressAd ,e?222'/�4 SZW,71� eZ,40¢
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aoState License / 99 Approved �"'t-L'"—'
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I,I X I UK : UMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater }(J I Size //
Water Closets ,� Mateca!
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
'.Pater Softeners Material
Bar Sinks To Main Drain
Comb. ,Sink c Trays To Curb
Dental Units
Drinking Fountains
t`loor Drains WATER SYSTEM
Hoppers Size y//
Restaurant Sinks Dlaterial
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
\Pater Leaders Storm Drain Pee
Sprinkler V.. \Prater Sys. Fee
Permit Fee
TOTAL TOTAL FEE p
RECORD OFINSPEC j�
Underground Rough...
.Partial Rough—
.Rough. Complete.. —
Main Drain
Final._
11