2740 aoaiil
eL LOT NO.
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D TLrry
FOR PLUMBING PERMIT
a OF CUPERTINO
Z-' o IMpY 21 1964 Sanitary No.
LL
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Dat � — r�196 Permit No
W u C1 V Fee $ C7 d
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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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and al er laws applicable t ereto.
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LLUse of Premises
00
3 Ad 77� 077 aZi //��
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CONT OR, EN7
30 3_
— Phon
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a LL State Licen o / 3 U Approved
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_U I PLUMBING INSPECTOR
I
_ UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units _
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee . D
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I Gill Water Sys. Fee i 0 c9
Permit Fee 2. 00
TOTAL TOTALFEE f4, 0 a
RECORD OF INSPECTION
Underground Rough...
Partial Rough.. /
Rough. Complete../ f
Slain Drain f
Final_.
I