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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