2463 /affil FFE . 4-
LOY NO.
NO. ST0.EF.T
in T4 N FOR PLUMBING PERMIT
a d IFITY OP CUPF.RTINO
r o VOCT 2 9 1963 sanitary No.
30 - 3
0 < Date /O `"- / 7 196= Permit No �
3u
= w CITY QF CUP�RTdN Fee $
0 Applica ion is here y made f 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
r < and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
w Use of Premises i �,S/ o%i✓C_',G
00
3 Owner E. O. T O N G S// Address /
z B .t.!!.S �� 117 7I'g Address %a/`�i'l 'T—X41l�� A
3 y CONTRACTOR, AGENT
— Phoney
w z
w w
ao State License 12 30C Approved`--
ji7 U PLUMBING INSPECTOR
FIXI URESNUMBER MAIN R I
UNITS FEESUNITS FEES
Water Heater / / I.DO Size e,
Water Closets g O Materia!
Nath Tubs t,OU To Curb
Showers Z ., Ov To Prop. Line Z,pO
LaXatories ¢ 4_D0 To Existing
Kitchen Sinks 3, 3, 00 1 Not Conn.
Dish Washers ) 1,00 Sewer Boxes
Waste Disposals 1.06
Wash Trays y,00 STORM DRAINAGE
Washing Machines 'Z 2,00 Size
Water Softeners J .00 Material
Bar Sinks To Main Drain
Comb. .Sink c Trays To Curb
Dental Units
Drinking Fountains
ploor Drains WATERS STEM
Hoppers SizeIts /,00
Restaurant Sinks Materi 0-;D G
San Traps TOTAL FEES
Urinals Fixture Fee . 00
Area Drains Main Drain Fee O'O
\Fater Leaders Storm Drain Fee
Sprinkler Vnwes Water Sys. Fee ( V
Permit Fee
TOTAL a TOTAL FEE
_Z'TIZZ-ZMAD OSPECTION
Underground Rough_ cam-
.Partial Rough..
Rough. Complete..
Main Drain —a3
Final... .,_,,