2721 / O ! y/ � ✓"• t -LOT NO.
N . STEEE.T
® RiMl l N&FOR PLUMBING PERMIT
Cis
OF CUPERTINO
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f 0 Sanitar y No.
MAY d 1964
0 A Date 196— Permit No
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' 0 Aj p1TYonaK,r�bPRFRtbT R hPCity 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. .�
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Use of Premises e l /y/ G / d
5 G(/
00
. Owner C Address,/ ud �.f/GC�Llr
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J z Bss t�,C � ''�✓�
a / ONTRACTO , AGENT ^
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Phone
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02 State cense Z� Approved Q
ao
M-U PLUMBING INSPECTOR
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FIX-1 URES NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was-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
Arca Drains Main Drain Fee
t r Le rs Storm Drain Fee
=n N-I r V. vcs Water Sys. Fee
Permit Fee _
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete-
Alain Drain
Final... TI V II Iy