2250 10S - QfIP/N S\W MIAh QN TNO. 17
NO. 0�STtE��� l �-
�� APPLICATION ,FOR PLUMBING PERMIT
TY�
d CI ,OP CUPERTINO
W = 1 JUL 12 1963
r o Sanitary No.
3 a Date i lUf�IG ^t1961� Permit No �� �lo
w� IY Pee $ �Gt
To
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
a w Cupertino, and all other laws applicable thereto.
4 Use of Premises 7
00
3 Owner xo �fzf C Address
0J
z By �fd.�/ti fd2 Address
O CONTRACTOR, AGENT '
3 m Phone ( � 1� ���179 t
0 w
< o State License ,//�/ , Approved
/, PLUMBINGINSPE•CLOR
FIXTURES M LMAIN DRAIN
UNITS I FEES UNITS FEES
Water Heater Z- dU Size TOO
Water Closets 5, 00 Materia!
Bath Tubs 3.00 To Curb
Showers / /, ct) To Prop. Line //
Lavatories 5 5-,d O To Existing
Kitchen Sinks 3.e d Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines ,00 Size r
A'ater Softeners Material _
Bar Sinks To Main Drain
Comb. Sink s, Trays To Curb
Dental Units
Drinking Fountains _ l
Floor Drains WATER SYSTEM
Hoppers , Size v
Restaurant Sinks Material r. .OQ
San Traps TOTAL FEES
Urinals Fixture Fee . 0 d
Area Drains Main Drain Fee '?,OT
% ter Leaders Storm Drain Fee
-prink," Voivcs Water Sys. Fee /•0
Permit Fee 2.00
TOTAL 42r.00 11 TOTAL FEE .Od
RECORD OF NSP TION
Underground Rough...
.Partial Rough..
.Rough, complete-.16-157—/--:51 i
,Main Drain _
Final-_