2526 02 a7 o�sl 4A �e 7m ( l A LOT NO. 3 Z
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® APPLICATION LfOR PLUMBING PERMIT
N
Y OF
w 0 tpEC 6 1963 ��� CUPERTINO
x o Sanitary h4,.
o < llate 6 1 496 3 Permit No ��
w LL Q. t� . lJ Fee $ (�3t?
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Application is hereby made to the City of Cupertino for a permit to install plumbing
opipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/ fixtures in accordance with the provisions of the Plumbing Cade of the City Of
m Cupertino, and all other laws applicable
thereto.
~ ~ Use of Premises I /Lt_.f 212
o_ o
> N
3 Owner Address
_� Q ,
o By Address /o.�Lo F— .
F CONTRACEOR,AGENT'
- 0 Phone ;252 -/90
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Quo) State License Approved��
vJJ PLUMBING INSPECCOR
C �
FIXTURES bBER MAIN DRAIN
UNITS F E UNITS FEES
Water Heate 4 ' Size
Water Closets I Material
Bath Tubs 3 To Curb
Showers 3 To Prop. Line
Lavatories To Existing
Kitchen Sinks 3 3 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals 9
��Vash Trays i, t STORM DRAINAGE
Washing Machines r Size
Water Softeners Material
Bar Sinks To Main Drain
Comb, Sink x Trays To Curb
Dental Units _
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTA FEES
Urinals Fixture Fee
Area Drains Main Drain Fee )l— Ln
eater Leaders Storm Drain Fee
-prinklrr Valves Water Sys. Fee GrV
Permit Fee CrZ
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough__
Rough Complete..
�4ain Drain
Final....