2700 L'J / I N/Y/i7 �liUE- LOT NO. 5/
NO. e r
APPY •I4FOR PLUMBING PERMIT
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CITY OF CUPL'RTINO
x a l APR 17 9964 t Sanitary No.
RLL Date IP'eiz- o 196Permit Nom�?
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3 `
CITY OF CUPS"
w Fee $ /6,00
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Application is hereb}' 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 Premises .Q—s 11P6/VC-r-
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3 Owner //y/c_JF //i o7- Address 19OYl1/. U/�ACf1FSTf/l f T
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3 r CONTRACTOR,AGENT
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– Z Phone �96�39(a
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aState License Approved
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a PLUMBING INSPECTOR
FIXTURES NUD BER MAIN DRAIN
UNITS F TES UNITS FEES
Wacer Heater Size
i
Wate; Closets Materia'_
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
\\cashing Machines / Size
'Nater Softeners Material
Bar Sinks To Main Drain
Comb, Sink e. Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hppj?ers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee a,DO
\Xrater Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee /,(JO
Permit Fee a,00
TOTAL // TOTAL FEE
RECORD OF INSPECTIO
Underground Rough. . _
.Partial Rough.. ,S- —
.Rough. Complete-
Main Drain
inal._