2497 / / I •LOT NO.
NO. CWTREE '
`AfPC TLt!
OR PLUMBING PERMIT
� a CIOP-CUPERTINO
r g NOV 12 1963 - sanitary No.
3 U Date
196 Permit No. f7
w CITY OF C�!P rt i il�� Fee $ °Q
O Application is hereby-made to the City of Cupertino fpr a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws a licable thereto.
w x
r �
w Use of Premises
00
> N
3 Owner $ress
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zBy Address 47
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3W1�,�UhNl
L /— w Phone
W z IS
? State License /`� e �-- - Approved (rtq
n/U PLT/'��111 E(.0 R
FIXTURES NU\ L• AI DRAIN
UNITS FEES UNITS FEES
'Water Heater Size
Ware; Closets Material t
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'sXliter Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor-Drams WATER SYSTEM
Hoppers Size Z"/
et
Restaurant SinksMateria 6 /r
Sand Traps /TOTAL FEES
Urinals Fixture Fee _
Arca Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Naives Water Sys. Fee r
Permit Fee 0.0
TOTAL ;j TOTAL FEE p
RECORD OF INSPECTION
Underground Rough..
L
le _ t