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2574 /O I / A.' ' LOT-NO. TRE CAI FOR PLUMBING PERMIT w !SJ JAN 15 1964 ' aF CUPt.RTINO Y 0Sanitary No. w ?S0 J Dat A,96_ Permit No 3U s �,r p w a Fee$ �4 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 a w Cupertino, and all othe laws applicable thereto. w x r Use of Premises 00 3X Owner f—'— Address 77 ? z AddWs�// J ON .. OR, AGENT �T 3 � — uQi tPhon ao ' State Licen Approved U PLUMBING INSPECTOR H. I URES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Water Heate Size Water Closets Material �. 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 ConT. Sinks Trays To Curb Dental Units Dunking Fountains Floor Drains WATER SYSTEM Hoppers ' Size 1 11 Restaurant Sinks Material 166"W:— Saqd Traps TOTAL FE Urinals Fixture Fee 3 rea Drains Main Drain Fee Q m eater Leaders Storm Drain Fee Sprinkler Volvos Water Sys. Fee ^'u Permit Fee ^U TOTAL TOTAL FEE RECORD OF INSPECTiLQN� Underground Rough..�.__��_l{ Partial Rough-- Rough. Complete- Main Drain _5?— Final--