1501 (2) An/ I /L/lf.9U/l s .0/l/lit_ LOT No. .2j
NO. STREET
D a1FOR PLUMBING PERMIT
I OF CUPERTINO
+y i APR 17 1962
Date 19Kz Permit No.__�✓O�
CITY OF CUPERTINO Fee $
y Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
or fixtures in accordance and/ es cco dance with the provisions of the Plumbing Code of the G of
I� g �
Cupertino, and all other laws applicable thereto.
L Use of Premises—
Owner
remises Owner 0Pr/l ur Address CvP`2?ivo
'By /0U.GOv P A/XfY'V/- Addr >
r CONTRACTOR, AGENT
Phone J 7 -E/// App
rov
r- PLUMBING INSPECTOR
rO 41
URCS UMBER 11 7�
iUNITS1 FERS:
UNITS I FEES I
iWater Heater, size
Water i-Cl Sets 3 Material C I
-6ath Tubs To Curb
-Showers To Prop. Line
To Existin
kitchen Sinks Not con.
OisS Washers
Vaste—Disposals I
-Wash Trays STORM DRXINAUL
Washing Machines Size
'Water�Softeners Material
To Main Drain
T-o—mE S,�nV&Trays To Curb
Dental U n—iI s —1
rDrinking Fountains
Floor Drains WA,]TR SYSTEM
--
i Hoppers Size 1�77' 1-11
[,Restaurant Snksr Material d;jlv.,
,-San, , raps TOTAL; EELS
U i als Fixture Fee
i,Arqa Drai Main Draih Fee
Storm Drain Fee
Water' Leaders
p,r J41ter Valves Fee
—���W.Tter Sys: oo
Permit Fee, o U
1.TO-TA L A7 TOTAL 11EE /71, 00
-�R C R D� I El (c---.'rI 10 N
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' 'Rough Roujh
Complete�:O
Rail
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