2534 (2) O ��� �• /_� __ _ .LOT NO.
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APPLICATION FOR PLUMBING PERMIT
w 2 'DEC 16 9963 Cir cuPFRrINo
, 0 Sanitary No.
LL �
o a DateC!T Cni tnrnr•,.1963 Permit No )r
w Fee $
2 LL
0 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
wCupertino, and all other lawapplicable thereto.
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3 Owner J v Ad ess
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01 State Licens a Approved
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PIX I URESSNUMBER I
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Mate' -
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 771L To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
%1Uash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Unit;
Drinking Fountains Aak
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Materia
San Traps TOTAL FEES
Urinals Fixture Fee 4
Area Drains Main Drain Fee Y 0
\Vater Leaders Storm Drain Fee
5prinklcr tip Nes Water Sys. Fee 40 0
Permit Fee Q
TOTAL TOTAL FEE C(j
RIkORD OF INSPECT
Underground Rough...
.Partial Rough..
.Rough. Complete.,4--
\4ain Drain
Fined...