2535 / — 'rLOT NO.'
'/:'A PLUMBING PERMIT
Na DEC 16 1963 C�ITY:OF CUPERTINO
z i
r o Sanitary No.
LL
oa Dat — -,..1963 Permit No '
3� ; t t r l.,rcm -
i LL Fee $ /� '�
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
<w Cupertino, and all other laws applicable thereto.
Wx
< r
j W Use of Premises
0 0
0
o < Owner Address
zJ
ZX,By -Address t�z ae nh ail
Z! oONTRACTOR,AGENT T
3 �
— < \Phon d 7 9,L/
Wz
State License 7°z 'Z�/ Approve
W
M
san
_U PLUMBING INSPECTOR
FIXTURES
UNITS I FEES UN[TS FEES
Water Heate Size
Water Closets Maters 2f
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\ -ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners - Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental•Umts -
Drinking Fountains
rloor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
t�/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee / 00
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough.-j/_3
Partial Rough._
Rough: Complete.. —
\'Iain Drain
�
r t