2689 \aY L-) A/r.' LOT NO. TO
NO. s rt TI
t' FOR PLUMBING PERMIT
b
ly .ItPY ,Op CUPGRTINO
r o /APR 17 1964 �'' . Sanitary Al
of Date l 19U,-q Permit No
LL CITY OF CUPERT; Pee $ I DO
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
i- 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.
,. Use of Premises Kms s elw�e�_
o050 I 1
r 3 Owner . Address 1408 N.111t,nc.lta�-I�.e �r1�1C6E-
iJ I I I
J z By c—101)aY'U I UYY1b�w �1�C,Address P n isn, Sc,n cc t_XC yo-
O CONTRACTOR,AGENT
3 h
- � Phone � 9 � - �q �3
ww � q
f State License �' ` I _ Approve
a o
eat
PLUMBING INSPECTOR
HX R .S NUMBER MAINDRAIN
UNITS FEES UNITS FEES
'.Cuter Heater Size
Ware, Closets Materi .
Hath Tubs / To Curb
Showers / ,e7p To Prop. Line
Lavatories 6V 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 a Trays To Curb
Dental Units
Drinking Fountains WH
Floor Drains WATER SYSTEM
Hoppers Size "
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee Gte
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee /,e)t5)
Permit Fee ,0O
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough... —
.Partial Rough.. —
.Rough Complete.. -
Main Drain
Final._ `