2509 0 LOT NO.
N STREET
® PPS_ L CA N-kOR PLUMBING PERMIT
z d �' °"'� T CUPERTINO
w ¢ ' Sanitary No.
X ° Nit
OV D 9 1963 a
0 Date 11 Permit No
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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
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws appy le thereto.
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Use of Premises
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O 3 Owner / r /� Address 1/J // / / A
z By /9/ 610 !^/' / /(/hl/19 Address �i` t'1141 ZC1 10 zlL AG{
3 O ITA'1�T �jAGENT
Phone-9/ / / �gR
0 z State License li C'y 1", Approved r
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PLUMBING INSPECTOR
FIXTURES NUMt E MAIN DRAIN
UNITS FRES UNITS FEES
Water Heater Size
Water Closets Materia'_
Bath Tubs To Curb
Showers To Prop. Line
Lavaturies 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 Units
Drinking Fountains
Floor Drains WATER SYSTEM
Poppers KNl'ai
Restaurant Sinks al
San Traps TOTAL FEES
Urinals Fee
Area Drains Drain Fee
Water Leaders Drain Fee
Tpririklcr Varves Sys. Fee
Fee
TOTAL L FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough-
.Rough. Complete..
\lain Drain — �y