2254 / Q / Y P ?/ LOT N6
(( FAL
SAtEF. `
PPLIATIONFOR PLUMBING PERMIT
za CI Y OP CUPERTINO
ro 12 1963 Sanitary No. _
3 U Date r r--Ur I't I ,��� Permit No _ G
W Fee $"
O 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
r r '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.
Use of Premises
00
oa Owner l S %� {`d Address
Z
J y �i�?//f10'l/'r-re,
� z Address
CO/ISTRACTOR, AGENT
3 N Phone
wz
Q(fpt_ State LicenseApproveLe
fJ PLUMBING INSPECTOR
FI. NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Z .d O Size ,00
Water Closets S,U O Materia'
Bath Tubs 3-0() To Curb
Showers /.,)o To Prop. Line
Lavatories c,^ 5—,co To Existing
Kitchen Sinks ,3 ,OQ Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Was-'ling Machines ,d4 Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers • Size 11,r
Restaurant Sinks Material
San Traps TOTAL F-FrES
Urinals Fixture Fee a/•6 0
Area Drains Main Drain Fee a,0 O
Water Leaders Storm Drain Fee
sprirnkler Valves Water Sys. Fee ,Q 0
Permit Fee a•60
TOTAL 2hoo TOTAL FEE a 4.U
RECORD OF INSPECTION
Underground Rough.. — 3
.Partial Rough.. — —3
Rough. Complete.. —
;Main Drain �/ "1�-
Final_.