2452 LOT NO.
NO. STREET
® 6,11 FOR PLUMBING PERMIT
z aY OP CUPERTINO
'� ° JOCT _163 2.t' Sanitary No..
pLL �y° a Date olL � 1963 Permit No. S;-1-
Pee $ a
° ApTa oOheDyy ly
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
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Cupertino, and all other laws applicable thereto.
Use of Premises
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oa Owner %1/�-� �" - Address� �= -t-� '�
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r CONTRACTOR, AGENT
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W w 7 Approved
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a o State License
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(L� PLUMBING INSPECTOR
FIXTURES NUD IN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Matcral
Bath Tubs / / To Curb
Showers 2 of To Prop. Line
Lavatories 3 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
Comb. Sink c Trays To Curb
Dental its
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee e
Arca Drains Main Drain Fees
Water Leaders Storm Drain Fee
Sprinkler Varves Water Sys. Fee 16"
Permit Fee
TOTAL �c� TOTAL FEE
RECORD OF INSPECTIO
Underground Rough.. 3
:Partial ROugh..
.Rough. Complete.. ^3
\Iain Drain
Final... r