2750 LOT NO.
NO. STREET U —�
'gftulyI FOR PLUMBING PERMIT
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OP CUPERTINO
Y 0 I JUN 3 1964 Sanitary No.
4 s�
o � Date 196_ Permit No
3a
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WI� W
Fee $ U U
OAF@`{V on 0her9pRtoNeOCity
of Cupertino for a permit to install plumbing
oa 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 other laws applicable thereto.
W x
Use of Premises
00
3 Owner l/UG /O T Address �y /
? z By C/9-1 i T �/�/1 �.SC�Y/�E Address
O CONTRACTOR,AGENT S�y �7�TEd
0 Phone —3 W— Lt'or
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W W
s State License4 7 Approved i>r
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-0 PLUMBING INSPECTOR
FIXI URLb NUIN BER
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
Comb. Sink s Trays To Curb
Dental Units'--
Drinking fountains
Floor Drains ATERSYSTEM
6
Hoppers 11 Size
Restaurant Sinks k# Material
S--nd Traps kq TOTAL FEES
L(rinals Fixture Fee
rea Drains Main Drain Fee
Nater Leaders Storm Drain Fee
Sprinkler Vol Water Sys. Fee
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough...— —
Partial Rough..
Rough Complete..
Main Drain
Final... p