2575 LOT NO.
N6. TREP.T
DOR PLUMBING PERMIT
< C I "OF CUPERTINO
fJAN 22 1964 a sanitary No.
o a Date Z 196 Permit No
3" CITY OF CUPF�RTI:��� Fee $ /
W a
O Application Ls hereby ma a to the City of Cupertino for a permit to install plumbing
`o < pipes and 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.
0 LL Use of Premises
0030 —
o a Owner. 41 AZ"
Address /0�� 22 Zd
z By��it c`1 .e-E Address-
115 14T
W z Phone
WW
L0
0 Y State License / Approve
a o
�U PLUMBING INSPECTOR
PIX I uRhb NUIX BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets 2- °o Material
Bath Tubs / To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks / Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wa9h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb, Sink s Trays To Curb
Defital Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /• ��
Restaurant Sinks Material
San Traps TOTAL FE
Urinals Fixture Fee p
re DDrains Main Drain Fee o"Lov
Water Leaders Storm Drain Fee
Tprinkkr Valves Water Sys. Fee bo
Permit Fee aoo
TOTAL poo TOTAL FEE �o
RECORD OF INSPEC O
Underground Rough ../-.;217—
Partial
ough .. /-.;2Partial Rough.. -
Rough. Complete.. a ..
Main Drain `)-
Final._ - 1