51046 (2) 10666 Rosewood LOT No,
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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W Y OF CUPERTINO `/�
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o ') Sanitary No. S
o Date 91,8�,6.7n .��� 1"XI"16-9Permit No 3
i LL Pee $ 71" s�4
LL w A Iication i, cr kyy� n d�•• to the City of Cupertino for a permit to install plumbing
o `< pipesl�'sn� or fixtirre hs c fi?i�tlielaverse side hereof, and agrees to install said prices
'z w 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.
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Use of Premises
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' " White Const365 La Prenda Wa
O 3 Owner . Address y
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-ioBy Winchester Plumbing Co- Address 1217 Dell Ave.
CONTRACTOR, AGENT
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— Phone 378-7615
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a WILLIAM D. BENEVICH
a o State License 6210245 Approved /
—U' I PLUMBING INSPECTOR (/
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IqIXTURES NUMBER
UNITS FEES UNITS FEES
Water Heate Size
Water Closets z, Material
Bath Tubs To-Curb
Showers To Prop. Line
Lavatories .Z 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
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 66ego
Area Drains Main Drain Fee
Water Leaders Fee 600
5prinklcr ValvesWater Sys. Fee /16-
Permit Fee ?
Do—
TO—TAL TOTAL FEE "OSD
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final