2252 74 141kOT NO.
NO. S't1lEE.T^
® APPLIC'ATION 01t PLUMBING PERMIT
z d Cl OF CUPERTINO
xI I JUL 12 1963 �' Sanitary No.
p 0 �/ / l
o a Date / —/ Z 196-2Permit No 12't
3_ C.TY OF CUPERT^'^ Fee $ a�
W LL
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
wCupertino, and all other laws applicable thereto.
w x
0 W Use of Premises
00
3 Owner f _ Address
iJ
z By Address
3 l/ ONTBACTO
— <Phone
02 State License ���� �7 Approved ,
ao
)n
Th PLUMBING INSPECTOR
,HXI UREb NUMBERIN DRA
UNITS FEES UNITS FEES
[itchen
ater Heater Z, o?,d0 Sizelater Closets ',d pMaterial.th Tubs -, pp To Curb
owers ,op To Prop. Linevatories ,0o To Existing
Sinks 3 3.00 Not Conn.
ish Washers Sewer Boxes
Vaste Disposals
'ash Trays STORM DRAINAGE
mashing Machines O Size
sVater Softeners Material
Bar Sinks To Main Drain
-omb. Sink s Trays To Curb
ental Units
Finking Fountains
Floor Drains WATER SYSTEM
Hoppers Size / 'r .d O
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee o2/.6 U
Arica Drains Main Drain Fee d G
Water Leaders Storm Drain Fee
_prinkler Vaivcs Water Sys. Fee /, 60
Permit Fee . 0
OTAL f11 TOTAL FEE ,0•a
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
\-Iain Drain
Pinal _.