2718 LOT NO.FG
NO. T
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R rel ON FOR PLUMBING PERMIT
s z (APR 27 1964 �ITY OF CUPGRTINO
m o — Sanitary No.
O " a3 -2 7/
0Ja Date 196 Permit No.
LL CITY OF CUPERT 1" , Fee 8 —
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
<w Cupertino, and all other laws applicable thereto.
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j Use of Premises
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aa Owne � �� i-���• Address�T/O 5•f1.9T///[o.9S'yi//,Cyv
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z By LY41 t�/c����in�i Address �/1 /.526 S�/Ull9�L�/r�9
O CONTRACTOR, AGENT
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— 0 Phone a96`396.3
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u Y State License. �75� 99 -Approved
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L PLUMBING INSPECTOR
FIXTURES UM MAIN R I
UNITS FEES UNITS FEES
Water Hentcr , Size
Water Closets �jl Mater;a]
Bath Tubs To Curb
Showers , 0 To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Di„h Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEMI
Hoppers Size
Restaurant Sinks Material L
San Traps TOTAL FRES
Urinals Fixture Fee
Area Drains Main Drain Fee ,
WVater Leaders Storm Drain Fee
Jprinkler Vntves Water Sys. Fee , O
Permit Fee ,
TOTAL TOTAL FEE
RECORD OF INSPECTI N
Underground Rough.. —1
.Partial Rough.. —
�Rough. Complete..
\4ain Drain
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