4708 L�Jo�� �J/�iG lA� O.PiGL LOT NO.
NO. S�j
� tPPLYCAT � FOR PLUMBING PERMIT
TY 01 CUPF.RTINa
6
t�3 ! APR 17 1964 '>>
r �o Sanitary- Na. _.
LL
3 < Date 9OQ/� /D/ `196 Permit No
w CITY OF/CLIPER T ;r Fee $
= o
� Application,is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
Z 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.
LL Use of Premises
00
> 0
r 3 Owner. Address 11,/08/U.
iJ /
z By ���»Qra������bi�ry Address "fOa'/.57J, SFJ�if ec.9,FSF}'
O CONTRACTOR.AGENT
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— W Phone -ft6 -.32�
w z
w w
ao State LicensApprove
U PLUMBING INSPECTOR
p
FIXTURESI I
UNITS FEES UNITS FEES
Warcr Heater , ) Size O
Water Closets 120 Matc,al (/c
Bath.Tubs , 9i) To Curb
Showers /, To Prop. Line j,
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Unifs
Drinking Fountains
Floor Drains WATER SYSTEM!
Hoppers Size
Restaurant Sinks Material Yrh j/
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinklcr Voivcs Water Sys. Fee
Permit Fee ,�(J
TOTAL TOTAL FEE
REGOR • OF INSPECTION
Underground Rough ,!v7-/ _
.Partial Rough..
.Rough. Complete.. 62 _
Main Drain p-
Final...