2443 rs{I/G/� f7t_r/r.n,G_I ✓�t'�// LOT NO.
NO. STREET
P� TpQN R PLUMBING PERMIT
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O o Date O C 3 X963 196'- Permit
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W LL ((�� ��// ((��[C (� Ip[pT nI Fee $ 16- U U
' 0 AppliDl s tkkby 5f��86 ER11IN of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r n 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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a F Use of Premises
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3 f- CONTRACTOR,AGENT
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K LL ��� Approved
/lo State License
PLUMBING INSPECIOA
FIXTURES NUMBER IN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets 3 • 3 Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks f Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'Mater Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dertta Units
Drinking Fountains
Pldor Drains WATER SYSTEM]
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee 4
Area Drains Main Drain Fee
Vater Leaders Storm Drain Fee
Jprinkler Varves Water Sys. Fee /
Permit Fee lfi
TOTAL / TOTAL FEE O d
RECORD OFINSPCpQt
Underground Rough../LI.-.2 -:5 �/ a
.Partial Rnu{;h_ //�' - 3
Rough. Complete..
Main Drain
Final...