2520 LOT NO.
P
.H .10" FOR PLUMBING PERMIT
za C1 F CUPERTINO
ro DEC� 1963 =-___-! Sanitary Nn. -- �\
3 < Date : 196— - Permit No. �S9CJ
U t 7G'
G
Fee $ �`�7
O Application is hereby made to the City of Cupertino for a permit to install plumbing
O-Q pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all otheijaws applicable thereto.j`
00 Use of Premises C,l 7
� 3 Owner , Address
z By ).ay 6 r e /' NA"DI k,4 Lv,TNe Address
O CONTRACTOR, AGEXT
— 0Z
Phone
W Z - /
ao State License 17 2 Approved
PLUMBING INSPECTOR
FIXTURES J BER
UNI FEES UNITS FEES
Water Heate Size
Water Closets Materiaf ? j
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
Ba'c Sinks To Main Drain
Com . Sink Trays To Curb
Dental Units _
Drinking Fountains
Floor Drains WATER SYSTEM
Floppers Size
.Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee Q(�
Area Drains Main Drain Fee
�Uater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee t7
Permit Fee
TOTAL TOTALFEE
RECORD OFINSP IO
Underground Rough,.
Partial Rough..
Rough. Complete.;
\Iain Drain
Final...