51205/0660
NO. STREET
LOT NO.
APPLICATION FOR PLUMBING PERMIT
CITY TS(--TPEfiTINO I�
41tar
Date — �� �� 196-� 1968Permit:No s/1d -S
Fee $ 02 A U—
Application is hereby' made to the City of Cuperreotiifnofor a�,permit to install plumbing
pipes and/or fixtures listed on, tli'd rev se si'ri itierTand a%rees to install said prices
and/or fixtures in accordance'-ivich the provisions of the Plumbing Code of the City of
Cupertino, and all -other -laws applicable thereto. - - -
Use of Premises �r�� :� de2il X-1
Owner . tic k T C a
By /%Ji97% S / it✓/= , �i L/ (�
CONTRACTOR,AGENT
Phone 'h1-57 :8 c5� 17 F
State License,2)3>'�7GZ
Address
WILLIAM D. 13ENEVICH
PLUMBING INSPECTOR f/
FIXTURES I NUMDER �� MAIN DRAIN
UNITS FF
UNI
Shower
To Pro . Line
Lavatories
To Existin
Kitchen 5ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washine Machine
Size
Comb.Sink & Tray I 1 11 To Curb I '
Floor Drain L WATER SYSTEM
Hopper Size I
TOTAL FEES
Main Drain Fee
Water Leader
Vac
I Total 1/ y 1 11 Total Fee J',Q-p I