2692 LOT NO.
NO. Ta
1 If FOR PLUMBING PERMIT
OF CUPERTINO
17 1964 Z __ Sanitary
y O /
O a DateA02/L /D 1968 Permit No b
LL CITY OF CUPERT; ,,0 Fee $ '00
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
> 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.
Wx
.a, W Use of Premises G-5/ :;�_yC&
00
' W �lX O rLL/UT Address/5' /I,/ C/J//lyl//FfTFc� 5
O 3 Owner
ZJ /
� o Address /ice /SD
3 �
— w Phone 161
W W
s State License / 7Sa9� - Approved
0
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I. R : NUIN PER —MA—IN—MIN
UNITS FEES UNITST FEES
`JVatcr Heater Size
Water Closets Materia':
Bath Tubs ,pp To Curb
Showers IoX To Prop. Lin
Lavatories 0,e To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'%Yater Softeners Material
Bar Sinks To Main Drain
Comb. Sink c Trays To Curb
Dental Uniti
Drinking Fountains
Flo Drams WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
SanTTraps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee BUD
Water Leaders Storm Drain Fee
Sprink kr Varves Water Sys. Fee 45Po
Permit Fee
TOTAL j / TOTAL FEE
RECORD OF INSPECT
Underground Rough.. 1171
.Partial Rough..
.Rough. Co
mplete..
.Main Drain