NO PERMIT NUMBER 14937 I /1jILlG14-r ( / • LOT NO.
. STREET
No APPLICATION FOR PLUMBING .PERMIT
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j �gp � CITY OF CUPEFRTINO
T- Sanitary No.
Date IA 1969- Permit No
wLL Fee � �• J
MO
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 law'sapplicable thereto.
Use oPremises w
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Address
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By
0 ��� Chaf�ac CirPPt Address
3 San lose°L�IIIUtut�
- Phone
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a WILLIAM D. BENEVICH
O Y State License Approved
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U PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater i5 Size a tZ
Water Closet !:—C Material
Bath Tub If I -Sb To Curb
Shower 6Z) To Prop. Line
Lavatories .pp To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine , r Size
Water Softener Material '
Bar Sink To Main Dr
Comb.Sink&Tray To C
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size iI SU
Restaurant Sink Material �,
Sand Trap TOTAL FEES
Urinal Fixture Fee DO
Area Drain Main Drain Fee n
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Pennit Fee . 00
Total nA Total Fee 0