2253 LOT NO •i/
NO. S STREET
4- PPL'1Cdlkf0l,,;FOR PLUMBING PERMIT
U 2 CIT OF CUPERTINO
xp t JUL 12 1963 > Sanitary No.
3 a Date / ^ � - -_ ( �iJ Permit No r—,
Li i r r CUPLK ��t�,-
I. wLL Fee
10
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 I
�lX
0 o Use of Premises T—
Z0
Owner / /^ �Gi r � Address
Address ��r��//��J�1'�—L�
BYE�c
m Phone. (�{ id
W ,
a ozok.4��.__a
State License
�'� 7 - Approve
—u� tis �LETR
FIXTURES NU
M L MAIN DRAIN
FEES UNITS FEES
Water 11cater a-OU Size �r( Z.d 0
Water Closets -0 U Materia'Bath Tubs jO U To Curb
Showers / U U To Prop. Line
Lavatories 00 To Existing
Kitchen Sinks ,O 0 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines 2 2,00 Size
'%%rater Softeners Material
Bar Sinks To Main Drain
Comb. .Sink s Trays To Curb
Dental-Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
ql
Restaurant Sinks Material /,0 o
SanT Traps TOTNL FEES
Urinals Fixture Fee a
area Drains Main Drain Fee a,00
.
Water Leaders IStorm Drain Fee
�prinkler V,wcs Water Sys. Fee x.00
Permit Fee 2,0o
TOTAL /,UU1 TOTAL FEE _
RECORD OF INSPECTIO 1
Underground Rough... 7 z;/-—
.Partial Rnugh..
�Rnugh. Complete..
Main Drain
Final... / nl.��