51089.1 (8) A � 21210 1' st e ad Rd LOT NO. Bldg . #8
NO. TRY
ATION flOLUMBING PERMIT
d TRY 31 i3W o 6"'U
z PERTINO
z i
E o Sanitary No.
0 a Date 5-21cm nc G[jpLPermit NO J'7 6 J',,
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0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> i- 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.
wx
� LLUse of Premises an.n+ +
mo„ o
00 001 American St .
> 0owner Herman Christensen Address San Carinc
�j 2301 Palm Ave .
J. W. McClenahan Co.
� z By Address Ro.+ Mo+....� R i • f
O CONTRACTOR, AGENT —�
3 < 345-1691
— `0 Phone
—
z
a a WILLIAM D. BENEVIC
i o State License 133158 Approved /
PLUMBING INSPECTOR /
FIXTURES NUb1BER MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
Water heater 1 1 1.5o H Size Y ! )
Water Closet /0 /S— Material JN
Bath 'rub /0 IS— To Curb
Shower To Prop. Line
Lavatories /0 IS— To Existing _
Kitchen Sink /0 /S_ Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEE
Urinal Fixture Fee
Area Drain Main Drain Fee .$ —
Water Leader Stono Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Cas FeeSe
Vac Breaker
Skimmer
Filter
/�pj Permit Fee Re D
Total 11Total Fee