2555 Vr�/�. ", � 'QL/.Id T LOT NO.
NO. NT
R PLUMBING PERMIT
" ¢ P Cltr CUPERTINO
= 8 1964
YoSanitary No.
J+o ` Dateim '/ 196te Permit No. o7 355
3
U
aCITY OF ClJPERTINO Fees /7oa
Application is hereby made to the City 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
Z'N and fixtures in accordance with the provisions of the Plumbing Code of the City of
¢ w Cupertino, and all other
flaws applicable thereto.
5 r Use of Premises . �'cs����✓�E
00
>N p
o.a Owner Address //9SC��/dE.✓E,<,`ii/fc�..✓e,
ZJ
0 gy J Gf� /!G/9.+i r •��� Address
9d�' X900
I Phone
w"W G/vi is
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'f State License ��2607 Approved
¢ 0
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FIXTURES ,
UNITS FEES UNITS FEES
Water Heater / 1,0e Size ff
Water Closets 3 .7 00 Material `?•Z
Bath Tubs / loo To Curbfof� ,00
howers / /oo To Prop. Line
Lavatories 4/ -5/,pp To Existing
Kitchen Sinks / /po Not Conn.
U—sh—W—as—hens -T Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines / lee Size
'.dater Softeners Material
Baa Sinks To Main Drain
Comb. Si s Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM -
Hoppers Size
Restaurant Sinks Materialll"Age /.o0
Sand Traps TOTAL FEES
Urinals Fixture Fee 2,00
Area Drains Main.Drain Fee 2• UO
Water Leaders Storm Drain Fee
Sprinkler Varves Water Sys. Fee 00
Permit Fee 2.p0
TOTAL 1 j p0 TOTAL FEE /7 co
RECORD OF INSPECTION
Underground Rough.. .^ _
:Partial Rough_
Rough. Complete..
Main Drain r
Final_. ' r