2698 • /�30/ f� 9 GrJ[ LOT NO. ry
NO. STREET
CAM IS'AN FOR PLUMBING PERMIT
d �FITY
OF
CUPERTINO
0 71 l PR 7 1964 t. �'' Sanitary \'n.
LL
3 a Date /01960 Permit No
LL "I�[ T6h ' tSU thSs ''t Pce C� ()
° A p icat is er y de to fhe 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 applicable thereto.
w x
LL Use of Premises �e
00
3 Owner f%ia
ZJ
z B to / t • Address/l .Q67-/SD . QlfW61a-
3 CONTRACTOR,AGENT
— Phone
wz
W w
aState License /75. 9 Approved
_ 0
PLUMBING INSPECTOR
—I iXr'UNUMBER MAINDRAIN
UNITS FEES UNITS1 FEES
Water Heater /,QG Size
Water Closets Materia.
Bath Tubs To Curb
Showers ,el To Prop. Lin
Lavatories Ud To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
ashing,Machines j /,6,)51 Size
'skater Softeners Material
Bar Sinks To Main Drain
Comb, Sink a Trays To Curb
D@nt.d Units
Drinking Fountains
Floor Drains 'WATER SYSTEM
Hoppers Size /I/
Restaurant SinksMaterial
San Traps TOTAL PEES
Urinals Fixture Fee Q
Area Drains Main Drain Fee a .06
Water Leaders Storm Drain Fee
Sprinkler Vnivcs Water Sys. Fee A 60
Permit Fee • p
TOTAL TOTAL FEE
FORD OL,I I
Un ergr c oug 1...
.Partial Rough..
.Rough. Complete..
\•Iain Drain
Final... O 1 I V^