2521 oW s I z & • 'LOT NO `- 2 —
No. ® 'sheat
S�
f� A PLICONjIFOR PLUMBING PERMIT
a C 6F CUP
xf DEC ERTINO
o 1963 sanitary No
Q LL
O j Date
,k.196—•— — Permit No
n 00
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CiTY
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o` < 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 all other I, s a "licable ther
0 a Use of Premises
3 (/Address
Oa
ZJ
z�By Address
OAACIOR,7 AGENT
3 Phone 37 F —�s 9 2 /
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W w
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a a o�State License �'�"
7Z l Approved
PLUMBING INSPEC[OR
4
141XTURES
UNITS FEES / UNITS FEES
Water Heate Size
Water Closets Materi
'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
Bier Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Iloor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee t)
�`..r'e-Drains Main Drain Fee
W
ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee �Q
Permit Fee Q
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough..
Partial Rough- I
Rough. Complete
Main Drain
r ai..
T