2157LOT NO. L- S
dTION FOR P-LUM81NG PERMIT
CITY OF CUPERTINO
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JUN 13 1963 Y
Yo Sanitary No.
LL a �-
o< DateTUFFE
, 196� Permit No
W LL Fee $'/
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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 rices
,. and/or fixtures in accordance with theprovisions of the Plumbing Code of the City of
< W Cupertino, and all other la apph bl thereto. .
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J LL Use of Premises
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o 7 State License Approved 2tk4A
CONTRACTOR_ AGENT
N AM PLUMBING INSPECTOR
Water Softeners
UNITS FEES I UNITS FEES
Water Heater
Size
ater Closets
Material r
Bath Tubs
To Curb
Showers
, To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
Nash Trays
STORM DRAINAGE
Water Softeners
Material
Bar Sinks
To Main Drain
"omb. Sink & Trays
To Curb
Dental Units
Storm Drain Fee
drinking Fountains
Water Sys. Fee
Floor Drains
WATER SYSTEM
Hoppers ,
Size j �/ „
Sana c raps
1 U I AL NESS
Jrinals '
Fixture Fee tr.
krea Drains
Main Drain Fee 7
Water Leaders
Storm Drain Fee
sprinkler v.uves
Water Sys. Fee
Permit Fee , d
TOTAL
/ /��- TOTAL FEE
RECORD OF INSPECTION
Underground Rough )
Partial Rough__
Rough Complete..
Hain Drain
Final._ �. 1—