2716 1�3 7y PiaEPsio�: O e.yE LOT No. A';
NO. TREI' �`
CA ICJIIFOR PLUMBING PERMIT
< (i% OF CUPERTINO
w ��APR 27 1964 r
I O Sanitary No.
xLL /�
o a DateA��/G — -,.IA6`� Permit No ;� ///
3 U C1T Fee $ YLO- ff2
wLL
� 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
rand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
LL Use of Premises 23P—
00
of Owners�� PCX�i AddressTiO
z
! oyAddress
3 �, CONTRACTOR, AG
— m Phone --�Z'9G - 39103
wz
aState LicensApproved
— 0
n PLUMBING INSPECTOR
FIXTURES D BER MAIN R I
UNITS FEES UNITS FEES
atcr Heater Size '
'ate, ClosetsMafera_
lavatories
ath Tubs To Curb
o Prop. Line
To Existing
'ftchen Sinks Not Conn.
>ish Washers Sewer Boxes
''aste Disposals
Vash Trays STORM DRAINAGE
Vashing Machines Size
Fater Softeners Material
iar Sinks To Main Drain
-omb,.Sink % Trays To Curb
)ental Units
>rinking Fountains i
'loor Drains WATER SYSTEM 11
uppers Size
tcstaurant Sinks Material
and Traps TOTAL FEES
Jrinals Fixture Fee ,
rea Drains Main Drain Fee
Vater Leaders Storm Drain Fee
Vmkler Vaives I Water Sys. Fee iv
Permit Fee ,Q
OTAL I TOTAL FEE dp
RECORD OF INSPECTION
nderground Rough..
Partial Rougb..
Rough, Complete.. —
\4ain Drain