2695 ioa 1 T a' LOT NO.
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*"a S EF.
L IT iN 'FOR PLUMBING PERMIT
d C[ Y� OF CUPERTINO
APR 17 1964 t_
ro Sanitary No.
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?0 Date ' I - / O f ,�Irj(> Permit No
w w Fee $ OO
To
� 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.
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w Use of PremisesE S//�E/(.✓=E
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oa Owner
ZO cf�� F` F'LL/dT / �-- Address 164
zB'—YOk/7 y�i81 ��c�i/i!,/ir4. 1hc, Address p0- /�47/SD $flf/T9�1fJP�
O CONTRACTOR, AGENT
3 �
— Phone a96—.396
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02
a State License -Approved 't/L
p — 0 PLUMBING�INSPECTO�R
V
I. R : NUMBER I DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets 3 Material
Bath Tubs To Curb
Showers 1,1,961 To Prop. Line
Lavatories To Existing
Kitchen Sinks / Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines .U Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
5Pr—kler Vawee Water Sys. Fee Z
Permit Fee
TOTAL ,4C56 TOTAL FEE
RECORD OF INSPECTIO
Underground Rough... _ —
.Partia! Rough.. —
Rough. Complete..
'Iain Drain t — —
Finalt..