2532 rY l.' �/ iSI^��Q .�W`.c�•1 .I /✓c;-E, LOT'NO.
NO. /gym �ShR6ftl'
EIPPLICATIO 'FOR PLUMBING PERMIT
w z DEC 16 9963
CITY).OF CUPERTINO
r o Sanitary No. �I/�
o � Date �T � ••�. -,•1963 Permit No.
W I t l UP CI( '• Fee $� �--�
= LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa 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
<w Cupertino, and all other laws applicable thereto.
w x '
� r
LL Use of Premises
00 n
3 Owner Address
oa
_ �OZ
-Cgy -} ` -� ' Address
3 GENT
NT
< KPIIOnP CT�z/
w z
w w �
¢ a
u
o 0�State Licens ��'� Approved
a
PLUMBING INSPECTOR
NXTURES M ER M7019TTkIN
UNITS FEES UNITSI FEES
Water Heater Size 411,'
Water Closets Materia•
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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains IT�K'�
Floor Drains WATER SYSTEM
Hoppers Size 1
Restaurant Sinks Mater'
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Feev�.00
\gater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee pQ
Permit Fee e7l Q
TOTAL TOTAL FEE r
RECORD OF INSPECT
Underground Rough..,e"2 . - ,3
.Partial Rough..
.Rough, Complete_ p _
\lain Drain /
Final...