2757 /✓" LOT NO.
NO. STREET
PL ON FOR -PLUMBING PERMIT
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Sanitar No.° JUN 16 1964 Y ��,s y
o a Date , 196_ Permit No
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cat is e 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
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a
In
Cupertino, and all othc,,jaws applicable thereto.
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CONTRACTOR,AGENT
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L tate License 7�y� Approved
-0 PLUMBING INSPECTOR
FIX RBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heatt uo
Size
Water Closets •v0 Material
Bath Tubs To Curb
Showers 77FiT To Prop. Line
Lavytories AV, .2•CIO To Existing
Kitchen Sinks 1,oo Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
TXK Trays STORM DRAINAGE
Washing Machines Size V "
Water Softeners Material G-R,
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units .
Drinking Fountains dv
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee J,
rea Drains Main Drain Fee ,db
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee 11010
,Vu Permit Fee U'V
TOTAL
1310`011TOTAL FEE 1111
RECORD OF INSPECTION
Underground Rough...
Partial Rough.
Rough. Compl
:Hain Drain
Final...