2473 LOT NO. Z ../
NO. FET EFT
FAPP -1c,10 fOR PLUMBING PERMIT
a CI Y ,OP CUPERTINO
' 0 �NOV1963 � sanitary No.
Eo
Y
x LL Q p
0 a Date(� r^i 27 196— Permit No 3
3U CITY OF CUPERT'" Pee $ 1
2 LL
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
a w Cupertino, and all other laws applicable thereto.
� a Use of Premises RESIDENCE
00
,- 3 Owner AV114,1q4l Gov vim Address G!/�fei%dg
iJ
o By Gee coPra3ccTo GE r Address
3 �
— m Phon 07'557.{/
u ? State License 99 Approved
a M S R
FIXTURES M E I R I
UNITS FEES UNITS FEES
Water Henter f Size *#
Water Closets Z Material 61"
Bath Tubs To Curb
Showers To Prop. Line
Lavatories j I To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
VVI Tshing Machine / Size
'skater Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Dri6king Fountains
Moor Drains WATER SYSTEM
Hoppers Size �
Restaurant Sinks Material Cop
San Traps TOTAL FEES
Urinals Fixture Fee /p, 0
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler vm�es Water Sys. Fee boy
Permit Fee 2100
TOTAL �D p TOTAL FEE /�Qv
RECORD OF INSPECTION
Underground Rough.. —�
.Partial
Rough-
Rough Complete.. _
.Main Drain l--
Final.- �' D a —