2717 _ .Sil�E O/UE LOT NO. O S _
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�A'PP GAT �`{j` FOR PLUMBING PERMIT
a (SPY OF CUPERTINO
x o IA'PR 27 1964 �` sanitary No.
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° a Dae /�i� /.0 23 196`f Permit No
U UI PERT:1' Pee $ � 'OJ
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° 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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0 3 Owner
T' �/�/ e '' U n Address J'`iU
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z B Address /�D� /Sa- SL7 dT9 GLflp�
° CONTRACTOR,AGENT /
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a Phone=99/— 9l0 3
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aU State License l Asa 99 - ApprovedU
PLUMBING INSPECTOR
FIXTURES NUM L MAI DRAIN
UNITS FEES UNITS FEES
Water Heater Size f
Water Closets �, Maicr:al
Bath Tubs To Curb
Showers D To Prop. Line
Lavatories To Existing
Kitchen Sinks `1 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
AOL-
Floor-Drains WATER SYSTEM
Hoppers Size oU
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee ho
Area Drains Main Drain Fee •��
\Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Pee D
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...= –
.Partial Rough.. -I—/ -
.RougL Complete.. — �?—
Main Drain
Final... 16 -