NO PERMIT NUMBER (8) LI /7 I ` LOT NO. 7
NO. STREET I
APPLICATION FOR PLUMBING PERMIT
i CITY OF CUPERTINO
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r o ® cis —+ 1 Sanitary No.
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3 a 196f Permit No
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iLL Fee -2 � Uy
° 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
rand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all o ler laws applicable thereto.
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LL Use of Premises �.
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oaOwnetAk _/n Gf / Address
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3 s nnCON�RACTOR,AGENT 625 Charles Street
— 0 PhoneZ I– GS3 L San lose, California 95112
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a WILLIAM D. BENM- CH
a o State License�7�537 Approved
U - PLUMBING INSPECTOR /
(J V fyXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater O Size
Water Closet 3f4.50 Material
Bath Tub 5b To Curb
Shower f. To Prop. Line
Lavatories 06 To Existing
Kitchen Sink / I•SO Not Conn.
Dish Washer I Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Dra'
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee n
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
S rinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee (7( )
Total /7- ' Dd Total Fee (JO